Healthcare Provider Details

I. General information

NPI: 1609062264
Provider Name (Legal Business Name): NORTH LAKE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 N LAKE AVE
PASADENA CA
91104-4557
US

IV. Provider business mailing address

756 N LAKE AVE
PASADENA CA
91104-4557
US

V. Phone/Fax

Practice location:
  • Phone: 626-794-4112
  • Fax:
Mailing address:
  • Phone: 626-794-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA

VIII. Authorized Official

Name: SAGUHI SARGSYAN
Title or Position: PRESEDENT
Credential:
Phone: 626-794-4112