Healthcare Provider Details

I. General information

NPI: 1154785731
Provider Name (Legal Business Name): MANYA KHRLOBYAN D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 12/08/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 W SUNSET BLVD 3RD FLOOR
LOS ANGELES CA
90027-6021
US

IV. Provider business mailing address

15031 RINALDI ST
MISSION HILLS CA
91345-1207
US

V. Phone/Fax

Practice location:
  • Phone: 818-468-4852
  • Fax:
Mailing address:
  • Phone: 818-365-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A16437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: