Provider Demographics
NPI:1407354384
Name:TAKVORIAN, LINDA JOYCE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JOYCE
Last Name:TAKVORIAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BARBOUR ST
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7715
Mailing Address - Country:US
Mailing Address - Phone:310-306-2427
Mailing Address - Fax:310-306-6427
Practice Address - Street 1:714 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5809
Practice Address - Country:US
Practice Address - Phone:310-522-4200
Practice Address - Fax:310-878-0230
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily