Individual provider Active NPI

Gayane Agekyan

  • Family Nurse Practitioner
  • Burbank, CA
National Provider Identifier
1063238525
Registry record updated Dec 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95030854 Issued in CA
Practice address
511 N Hollywood Way
Burbank, CA 91505-3406
Phone
(818) 841-0810
NPI assigned
Dec 2, 2024
Last updated
Dec 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95030854 CA Primary

Addresses

Primary practice location

511 N Hollywood Way
Burbank, CA 91505-3406

Mailing address

511 N Hollywood Way
Burbank, CA 91505-3406
Phone (818) 841-0810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250107002893 CA Practitioner - Nurse Practitioner 6103354998 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95030854CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Diagnostic Medical Group of California Inc Family CurrentSince Dec 27, 2024 Accepting new patients
Minuteclinic Diagnostic Medical Group of Orange County Inc Family CurrentSince Dec 27, 2024 Accepting new patients
Minuteclinic Diagnostic Medical Group of San Diego Inc Family CurrentSince Dec 27, 2024 Accepting new patients
Garfield Beach CVS LLC PastSince Dec 1, 2024 Accepting new patients
Garfield Beach CVS, L.L.C. PastSince Dec 1, 2024 Accepting new patients

Locations

1401 S Baldwin Ave
Arcadia, CA 91007
Phone (626) 321-4210

511 N Hollywood Way
Burbank, CA 91505
Phone (818) 841-0710

2760 Fletcher Pkwy
El Cajon, CA 92020
Phone (619) 461-4411

7096 N West Ave
Fresno, CA 93711
Phone (559) 436-0471

14330 Culver Dr
Irvine, CA 92604
Phone (949) 559-8129

11428 Kenyon Way
Rancho Cucamonga, CA 91701
Phone (909) 589-4098

921 Pacific Coast Hwy
Seal Beach, CA 90740
Phone (562) 598-0473

33205 US Highway 79
Temecula, CA 92592
Phone 9513033164 ext. 8221

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1063238525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 N HOLLYWOOD WAY",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915053406",
            "telephone_number": "818-841-0810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 N HOLLYWOOD WAY",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915053406",
            "telephone_number": "818-841-0810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGEKYAN",
        "first_name": "GAYANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-02",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95030854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.