Healthcare Provider Details

I. General information

NPI: 1538434196
Provider Name (Legal Business Name): MS. RIPSIK GUKASYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W 34TH ST DEN 4278
LOS ANGELES CA
90089-0641
US

IV. Provider business mailing address

121 SINCLAIR AVE #117
GLENDALE CA
91206-4005
US

V. Phone/Fax

Practice location:
  • Phone: 213-740-9474
  • Fax: 213-740-7965
Mailing address:
  • Phone: 818-548-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number46262
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number46262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: