Provider Demographics
NPI:1750041349
Name:KUMJIAN, LARA MARIA (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:MARIA
Last Name:KUMJIAN
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 POLARIS DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2425
Mailing Address - Country:US
Mailing Address - Phone:818-823-6065
Mailing Address - Fax:
Practice Address - Street 1:1914 POLARIS DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-2425
Practice Address - Country:US
Practice Address - Phone:818-823-6065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily