Healthcare Provider Details

I. General information

NPI: 1902085319
Provider Name (Legal Business Name): TARON MKRTCHYAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13627 1/2 VICTORY BLVD
VAN NUYS CA
91401-6451
US

IV. Provider business mailing address

13627 1/2 VICTORY BLVD
VAN NUYS CA
91401-6451
US

V. Phone/Fax

Practice location:
  • Phone: 818-785-6603
  • Fax:
Mailing address:
  • Phone: 818-785-6603
  • Fax:

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: TARON MKRTCHYAN
Title or Position: OWNER
Credential:
Phone: 818-785-6603