Provider Demographics
NPI:1508488891
Name:TADEVOSYAN, ARMINE (FNP)
Entity Type:Individual
Prefix:
First Name:ARMINE
Middle Name:
Last Name:TADEVOSYAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16101 VENTURA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2514
Mailing Address - Country:US
Mailing Address - Phone:818-533-8393
Mailing Address - Fax:
Practice Address - Street 1:16101 VENTURA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2514
Practice Address - Country:US
Practice Address - Phone:818-533-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily