Provider Demographics
NPI:1437771276
Name:AVETYAN, EDIK (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:EDIK
Middle Name:
Last Name:AVETYAN
Suffix:
Gender:M
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 1:839 WATERCRESS LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1403
Mailing Address - Country:US
Mailing Address - Phone:760-490-8036
Mailing Address - Fax:
Practice Address - Street 1:839 WATERCRESS LN
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1403
Practice Address - Country:US
Practice Address - Phone:760-490-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily