Healthcare Provider Details

I. General information

NPI: 1730631656
Provider Name (Legal Business Name): NAREK HARUTYUNYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 HOLLYWOOD BLVD STE 205
LOS ANGELES CA
90028-5496
US

IV. Provider business mailing address

2853 ALOHA ST
CAMARILLO CA
93010-2205
US

V. Phone/Fax

Practice location:
  • Phone: 213-399-9209
  • Fax:
Mailing address:
  • Phone: 213-399-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: