Provider Demographics
NPI:1659643815
Name:OGLAKHCHIAN, MARIAM (FNP)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:OGLAKHCHIAN
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 1:411 N CENTRAL AVE
Mailing Address - Street 2:130
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2081
Mailing Address - Country:US
Mailing Address - Phone:818-240-8767
Mailing Address - Fax:818-502-0254
Practice Address - Street 1:411 N. CENTRAL AVE
Practice Address - Street 2:130
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203
Practice Address - Country:US
Practice Address - Phone:818-240-8767
Practice Address - Fax:818-502-0254
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily