Healthcare Provider Details

I. General information

NPI: 1588445126
Provider Name (Legal Business Name): SIRANUYSH GEVORKYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9756 HASKELL AVE
NORTH HILLS CA
91343-2017
US

IV. Provider business mailing address

9756 HASKELL AVE
NORTH HILLS CA
91343-2017
US

V. Phone/Fax

Practice location:
  • Phone: 323-573-7592
  • Fax:
Mailing address:
  • Phone: 323-573-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: