Healthcare Provider Details

I. General information

NPI: 1588361646
Provider Name (Legal Business Name): ELIZABETH OGANESYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11080 W OLYMPIC BLVD
LOS ANGELES CA
90064-1937
US

IV. Provider business mailing address

8526 LURLINE AVE
WINNETKA CA
91306-1223
US

V. Phone/Fax

Practice location:
  • Phone: 310-966-6500
  • Fax:
Mailing address:
  • Phone: 747-238-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: