Healthcare Provider Details

I. General information

NPI: 1962332007
Provider Name (Legal Business Name): LUSEH CBAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 EAGLE ROCK BLVD
EAGLE ROCK CA
90041-3213
US

IV. Provider business mailing address

4420 EAGLE ROCK BLVD
EAGLE ROCK CA
90041-3213
US

V. Phone/Fax

Practice location:
  • Phone: 310-962-5858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDVIN TSATURYAN
Title or Position: PRESIDENT
Credential:
Phone: 310-962-5858