Healthcare Provider Details

I. General information

NPI: 1265784532
Provider Name (Legal Business Name): LAZIK DER SARKISSIAN, MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N CENTRAL AVE 205
GLENDALE CA
91203-1916
US

IV. Provider business mailing address

540 N CENTRAL AVE 205
GLENDALE CA
91203-1916
US

V. Phone/Fax

Practice location:
  • Phone: 818-243-9463
  • Fax: 818-243-5416
Mailing address:
  • Phone: 818-243-9463
  • Fax: 818-243-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberAO41167
License Number StateCA

VIII. Authorized Official

Name: LAZIK DER SARKISSIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 818-243-9463