Healthcare Provider Details

I. General information

NPI: 1679678882
Provider Name (Legal Business Name): ALVINA LUSINYAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 HOLLYWOOD BLVD
LOS ANGELES CA
90027-6103
US

IV. Provider business mailing address

5005 HOLLYWOOD BLVD
LOS ANGELES CA
90027-6103
US

V. Phone/Fax

Practice location:
  • Phone: 323-662-9308
  • Fax: 323-662-5970
Mailing address:
  • Phone: 323-662-9308
  • Fax: 323-662-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: