Healthcare Provider Details

I. General information

NPI: 1790242758
Provider Name (Legal Business Name): LA MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W GLENOAKS BLVD STE 200
GLENDALE CA
91202-4045
US

IV. Provider business mailing address

501 W GLENOAKS BLVD STE 200
GLENDALE CA
91202-4045
US

V. Phone/Fax

Practice location:
  • Phone: 818-696-2156
  • Fax: 818-396-4448
Mailing address:
  • Phone: 818-696-2156
  • Fax: 818-396-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LUSINE APIKYAN
Title or Position: PRESIDENT
Credential: ANP
Phone: 818-696-2156