Healthcare Provider Details

I. General information

NPI: 1790860385
Provider Name (Legal Business Name): ASTGIK SOGHOMONIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 7TH ST
SANGER CA
93657-2419
US

IV. Provider business mailing address

1348 7TH STREET
SANGER CA
93657-2419
US

V. Phone/Fax

Practice location:
  • Phone: 559-876-2551
  • Fax: 559-876-1911
Mailing address:
  • Phone: 559-876-2551
  • Fax: 559-876-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number100201
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ASTGIK SOGHOMONIAN
Title or Position: OWNER
Credential:
Phone: 559-876-2551