Healthcare Provider Details

I. General information

NPI: 1619525250
Provider Name (Legal Business Name): LAUREL GROVE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5437 LAUREL CANYON BLVD STE 107
VALLEY VILLAGE CA
91607-4615
US

IV. Provider business mailing address

5437 LAUREL CANYON BLVD STE 107
VALLEY VILLAGE CA
91607-4615
US

V. Phone/Fax

Practice location:
  • Phone: 747-204-8884
  • Fax: 213-481-9944
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NAREK OGANYAN
Title or Position: MANAGER
Credential:
Phone: 747-204-8884