Provider Demographics
NPI:1649096744
Name:MANOUKIAN, MARIAM (FNP)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:MANOUKIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24521 FARROW DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3143
Mailing Address - Country:US
Mailing Address - Phone:303-562-5673
Mailing Address - Fax:
Practice Address - Street 1:24521 FARROW DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3143
Practice Address - Country:US
Practice Address - Phone:303-562-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032836363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner