Individual
DIANA I IAZICHYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17117 TRIBUNE ST, GRANADA HILLS, CA 91344-4938
(818) 983-3360
Mailing address
17117 TRIBUNE ST, GRANADA HILLS, CA 91344-4938
(818) 983-3360
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95016074
CA
363LF0000X
Family Nurse Practitioner
Primary
95016074
CA
Other
Enumeration date
11/27/2020
Last updated
11/29/2020
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