Provider Demographics
NPI:1639913817
Name:ESSAGHOLIAN, ANNIE A (NP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:A
Last Name:ESSAGHOLIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10206 GENESTA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1627
Mailing Address - Country:US
Mailing Address - Phone:818-726-3353
Mailing Address - Fax:
Practice Address - Street 1:10206 GENESTA AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1627
Practice Address - Country:US
Practice Address - Phone:818-726-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily