Provider Demographics
NPI:1881189892
Name:GRIGORYAN, SAMUEL T (NP)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:T
Last Name:GRIGORYAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 E ESCALON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5734
Mailing Address - Country:US
Mailing Address - Phone:559-495-8706
Mailing Address - Fax:
Practice Address - Street 1:29982 IVY GLENN DR STE 203
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2097
Practice Address - Country:US
Practice Address - Phone:949-309-7903
Practice Address - Fax:949-716-5243
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95165516163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health