Provider Demographics
NPI:1598829434
Name:KARAPETYAN, KRISTINA (PA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:KARAPETYAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1110
Mailing Address - Country:US
Mailing Address - Phone:818-291-9747
Mailing Address - Fax:
Practice Address - Street 1:401 S. GLENOALS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1911
Practice Address - Country:US
Practice Address - Phone:818-748-1740
Practice Address - Fax:818-748-1741
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18057363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316113145Medicaid
CA1598829434Medicaid
CAPA18057OtherCA PA LIC
CAA0798ZMedicare PIN
CAAS743AMedicare PIN