Perla Kelenjian

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95020738 Issued in CA

Practice address

4950 San Bernardino St Ste 218
Montclair, CA 91763-2328

Phone

(909) 624-8019

NPI assigned

Oct 19, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1235855339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 W BENNETT AVE APT A",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917412578",
            "telephone_number": "626-502-2785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 SAN BERNARDINO ST STE 218",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632328",
            "telephone_number": "909-624-8019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELENJIAN",
        "first_name": "PERLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-19",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95020738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1985",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "nextgen",
            "affiliation": "N",
            "address_1": "4950 San Bernardino St Ste 218",
            "city": "Montclair",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917632328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Nurse Practitioner in Montclair, CA
• Providers in Montclair, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.