Provider Demographics
NPI:1689959645
Name:NIKOGHOSSIAN, SONA (FNP)
Entity Type:Individual
Prefix:
First Name:SONA
Middle Name:
Last Name:NIKOGHOSSIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SONA
Other - Middle Name:
Other - Last Name:NIKOGHOSSIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-4265
Mailing Address - Fax:323-361-7954
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-361-4265
Practice Address - Fax:323-361-7954
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP21171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMN2865737OtherDEA