Provider Demographics
NPI:1730906587
Name:MIRZAKHANYAN, NINA (FNP-C)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:MIRZAKHANYAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23046 LEONORA DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6122
Mailing Address - Country:US
Mailing Address - Phone:818-572-7375
Mailing Address - Fax:
Practice Address - Street 1:26527 AGOURA RD STE 104
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1935
Practice Address - Country:US
Practice Address - Phone:818-572-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily