Healthcare Provider Details

I. General information

NPI: 1528557352
Provider Name (Legal Business Name): CENTRAL MEDICAL BUSINESS MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N BRAND BLVD STE 404
GLENDALE CA
91202-2973
US

IV. Provider business mailing address

1141 N BRAND BLVD STE 404
GLENDALE CA
91202-2973
US

V. Phone/Fax

Practice location:
  • Phone: 818-247-9717
  • Fax: 818-247-9760
Mailing address:
  • Phone: 818-247-9717
  • Fax: 818-247-9760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSANNA YAGUBYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-247-9717