Individual provider Active NPI

Kristina Vartanian, NP

  • Nurse Practitioner
  • Long Beach, CA
National Provider Identifier
1609599562
Registry record updated May 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95022779 Issued in CA
Practice address
1050 Linden Ave
Long Beach, CA 90813-3321
Phone
(562) 491-9000
NPI assigned
Sep 26, 2022
Last updated
May 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95022779 CA Primary

Addresses

Primary practice location

1050 Linden Ave
Long Beach, CA 90813-3321

Mailing address

1760 Termino Ave Ste G18
Long Beach, CA 90804-2169

Other practice location 1

5750 Downey Ave
Lakewood, CA 90712-1405
Phone (562) 531-2550

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
I20221229001132 CA Practitioner - Nurse Practitioner 6002286408 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95022779CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Partners, a Medical Group Current Accepting new patients
Prohealth Partners a Medical Group Inc CurrentSince Dec 1, 2022 Accepting new patients
Prohealth Partners, a Medical Group, Inc. CurrentSince Dec 1, 2022 Accepting new patients

Locations

1050 Linden Ave
Long Beach, CA 90813
Phone (562) 491-9000

1760 Termino Ave
Ste 214
Long Beach, CA 90804
Phone (562) 595-4718

1760 Termino Ave
Ste G18
Long Beach, CA 90804
Phone (562) 494-6700

File 54567
Los Angeles, CA 90074
Phone (310) 491-9060

4101 Torrance Blvd
Torrance, CA 90503
Phone (310) 540-7676

4201 Torrance Blvd
Ste 350
Torrance, CA 90503
Phone (310) 540-5494

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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": "1664150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684972800000",
    "number": "1609599562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1760 TERMINO AVE STE G18",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908042169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 LINDEN AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133321",
            "telephone_number": "562-491-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5750 Downey Ave",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CA",
            "postal_code": "907121405",
            "country_code": "US",
            "telephone_number": "562-531-2550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VARTANIAN",
        "first_name": "KRISTINA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-26",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95022779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.