Healthcare Provider Details

I. General information

NPI: 1891576211
Provider Name (Legal Business Name): PROSPERITY HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12444 VICTORY BLVD # 308
NORTH HOLLYWOOD CA
91606-3199
US

IV. Provider business mailing address

9018 BALBOA BLVD # 281
NORTHRIDGE CA
91325-2610
US

V. Phone/Fax

Practice location:
  • Phone: 213-444-9092
  • Fax: 213-444-9092
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARAPET MIRAKYAN
Title or Position: CEO
Credential: NP
Phone: 213-444-9092