Provider Demographics
NPI:1942767330
Name:KARAPETYAN, VARDUHI
Entity type:Individual
Prefix:
First Name:VARDUHI
Middle Name:
Last Name:KARAPETYAN
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 1:600 W BROADWAY STE 120
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1023
Mailing Address - Country:US
Mailing Address - Phone:818-641-4067
Mailing Address - Fax:
Practice Address - Street 1:600 W BROADWAY STE 120
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1023
Practice Address - Country:US
Practice Address - Phone:818-641-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner