Provider Demographics
NPI:1710670641
Name:BELADJIAN, GINNEY MARY (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:GINNEY
Middle Name:MARY
Last Name:BELADJIAN
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WILSON TER STE 340
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4072
Mailing Address - Country:US
Mailing Address - Phone:818-543-7574
Mailing Address - Fax:818-956-7609
Practice Address - Street 1:1505 WILSON TER STE 340
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4072
Practice Address - Country:US
Practice Address - Phone:818-543-7574
Practice Address - Fax:818-956-7609
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily