Provider Demographics
NPI:1841327012
Name:KIRAKOSIAN, LENA MARY (MSN FNP)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:MARY
Last Name:KIRAKOSIAN
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SAN PABLO ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5392
Mailing Address - Country:US
Mailing Address - Phone:323-442-5900
Mailing Address - Fax:323-442-5714
Practice Address - Street 1:1520 SAN PABLO ST STE 1300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5392
Practice Address - Country:US
Practice Address - Phone:323-442-5900
Practice Address - Fax:323-442-5714
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9094363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP9094OtherSTATE LICENSE
CARN503638Medicaid
CABN056ZOtherMEDICARE
CANP9094OtherSTATE LICENSE
CAP86198Medicare UPIN
CAWNP9094CMedicare PIN