Provider Demographics
NPI:1942930318
Name:KHATCHERIAN, GRIGOR (FNP)
Entity Type:Individual
Prefix:
First Name:GRIGOR
Middle Name:
Last Name:KHATCHERIAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8927 STANSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-2532
Mailing Address - Country:US
Mailing Address - Phone:818-641-7156
Mailing Address - Fax:
Practice Address - Street 1:8927 STANSBURY AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2532
Practice Address - Country:US
Practice Address - Phone:818-641-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily