Provider Demographics
NPI:1730726357
Name:KUIUMJIAN, TATEVIK VICKY
Entity type:Individual
Prefix:
First Name:TATEVIK
Middle Name:VICKY
Last Name:KUIUMJIAN
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 1:9561 TEXHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2046
Mailing Address - Country:US
Mailing Address - Phone:818-456-8126
Mailing Address - Fax:
Practice Address - Street 1:9561 TEXHOMA AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-2046
Practice Address - Country:US
Practice Address - Phone:818-456-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA847187163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical