Healthcare Provider Details

I. General information

NPI: 1912546250
Provider Name (Legal Business Name): HILDA GABRIYELYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 YORK BLVD
LOS ANGELES CA
90042-3639
US

IV. Provider business mailing address

601 E LOMITA AVE APT 3
GLENDALE CA
91205-2281
US

V. Phone/Fax

Practice location:
  • Phone: 323-550-1317
  • Fax:
Mailing address:
  • Phone: 818-395-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number81147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: