Provider Demographics
NPI:1679354542
Name:DZHAMBAZIAN, ALINA (NP)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:DZHAMBAZIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21084
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-5184
Mailing Address - Country:US
Mailing Address - Phone:323-783-8861
Mailing Address - Fax:
Practice Address - Street 1:1526 N EDGEMONT ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5260
Practice Address - Country:US
Practice Address - Phone:323-783-8861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95078402163W00000X
CA95027504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse