Healthcare Provider Details

I. General information

NPI: 1386781599
Provider Name (Legal Business Name): GOAR MNATSAKANIAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 W GLENOAKS BLVD SUITE # 103
GLENDALE CA
91201-1930
US

IV. Provider business mailing address

1540 W GLENOAKS BLVD SUITE # 103
GLENDALE CA
91201-1930
US

V. Phone/Fax

Practice location:
  • Phone: 818-548-8028
  • Fax: 818-548-8106
Mailing address:
  • Phone: 818-548-8028
  • Fax: 818-548-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number20704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: