Healthcare Provider Details

I. General information

NPI: 1336786151
Provider Name (Legal Business Name): TATEVIK OVASAPYAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2019
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9341 CRYSTAL VIEW DR
TUJUNGA CA
91042-3239
US

IV. Provider business mailing address

9341 CRYSTAL VIEW DR
TUJUNGA CA
91042-3239
US

V. Phone/Fax

Practice location:
  • Phone: 818-517-3842
  • Fax:
Mailing address:
  • Phone: 818-517-3842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number25200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: