Healthcare Provider Details

I. General information

NPI: 1861697401
Provider Name (Legal Business Name): MRS. LUSYA NALBANDYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N CENTRAL
GLENDALE CA
91205
US

IV. Provider business mailing address

200 W PALMER AVE APT C
GLENDALE CA
91204
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-8155
  • Fax: 818-956-0258
Mailing address:
  • Phone: 818-246-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH63840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: