Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tatevik Grigoryan

Individual provider Registered Nurse · NPI 1477302305

Tatevik Grigoryan is a Nurse Practitioner in Fremont, California. Qualified in 2023, 3 years ago. Accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
3
Licensed in
CA
In the registry since
2024
Specialties on file
2
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Practice location Address checks out

39159 Paseo Padre Pkwy Ste 121
Fremont, CA 94538-1600
Phone: (510) 952-1190
Fax: (510) 972-5976
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 95028093 (CA)
Registered Nurse Taxonomy 163W00000X · Licence 95222787 (CA)

Record details

NPI number1477302305
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMay 14, 2024
Last updated in NPPESMay 14, 2024
Certification dateMay 6, 2024
Mailing address18325 Sherman Way, Suite B, Reseda, CA 91335

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Fremont