Provider Demographics
NPI:1477191070
Name:OGANESYAN, KNARIK (FNP PMHNP)
Entity Type:Individual
Prefix:
First Name:KNARIK
Middle Name:
Last Name:OGANESYAN
Suffix:
Gender:F
Credentials:FNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BIRMINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3908
Mailing Address - Country:US
Mailing Address - Phone:818-424-7977
Mailing Address - Fax:
Practice Address - Street 1:1311 N SAN FERNANDO BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4236
Practice Address - Country:US
Practice Address - Phone:818-843-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013487363LF0000X, 364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily