Healthcare Provider Details

I. General information

NPI: 1629656772
Provider Name (Legal Business Name): VIGUEN MOVSESIAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 W OLYMPIC BLVD STE 217
LOS ANGELES CA
90006-6507
US

IV. Provider business mailing address

3030 W OLYMPIC BLVD STE 217
LOS ANGELES CA
90006-6507
US

V. Phone/Fax

Practice location:
  • Phone: 213-550-2159
  • Fax: 888-820-9903
Mailing address:
  • Phone: 213-550-2159
  • Fax: 888-820-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIGUEN MOVSESIAN
Title or Position: OWNER/CEO
Credential: MD
Phone: 310-291-0333