Provider Demographics
NPI:1750152211
Name:TADEVOSYAN, TIGRANUHI TINA
Entity type:Individual
Prefix:
First Name:TIGRANUHI
Middle Name:TINA
Last Name:TADEVOSYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 N LIMA ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1527
Mailing Address - Country:US
Mailing Address - Phone:818-726-2883
Mailing Address - Fax:
Practice Address - Street 1:1821 N LIMA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1527
Practice Address - Country:US
Practice Address - Phone:818-726-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily