Healthcare Provider Details

I. General information

NPI: 1518105717
Provider Name (Legal Business Name): NONA N OGANISYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W COLORADO ST SUITE 104
GLENDALE CA
91204-1175
US

IV. Provider business mailing address

1317 ALAMEDA AVE
GLENDALE CA
91201-1119
US

V. Phone/Fax

Practice location:
  • Phone: 818-455-9722
  • Fax: 818-500-0223
Mailing address:
  • Phone: 818-455-9722
  • Fax: 818-500-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: