Healthcare Provider Details

I. General information

NPI: 1023637337
Provider Name (Legal Business Name): NAIRA SARGSYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 E BROADWAY
GLENDALE CA
91205-1110
US

IV. Provider business mailing address

519 E BROADWAY
GLENDALE CA
91205-1110
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-3020
  • Fax: 818-243-2713
Mailing address:
  • Phone: 818-409-3020
  • Fax: 818-243-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A21427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: