Healthcare Provider Details

I. General information

NPI: 1992581110
Provider Name (Legal Business Name): IMMUNITY CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 N GLENOAKS BLVD
BURBANK CA
91504-2835
US

IV. Provider business mailing address

2010 N GLENOAKS BLVD
BURBANK CA
91504-2835
US

V. Phone/Fax

Practice location:
  • Phone: 818-906-4404
  • Fax:
Mailing address:
  • Phone: 818-906-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: VILIK HARUTYUNYAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-793-7452