Healthcare Provider Details

I. General information

NPI: 1265290720
Provider Name (Legal Business Name): PALMYRA CBAS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8351 SAN FERNANDO RD
SUN VALLEY CA
91352-3225
US

IV. Provider business mailing address

8351 SAN FERNANDO RD
SUN VALLEY CA
91352-3225
US

V. Phone/Fax

Practice location:
  • Phone: 818-668-3941
  • Fax: 818-921-3656
Mailing address:
  • Phone: 818-668-3941
  • Fax: 818-921-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REPSIME TERPETROSYAN
Title or Position: CEO
Credential:
Phone: 818-668-3941