Healthcare Provider Details

I. General information

NPI: 1801836226
Provider Name (Legal Business Name): SHUSHANIK MARTIROSYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14621 TITUS ST
VAN NUYS CA
91402-4908
US

IV. Provider business mailing address

14621 TITUS ST
VAN NUYS CA
91402-4908
US

V. Phone/Fax

Practice location:
  • Phone: 818-781-5225
  • Fax: 818-781-5378
Mailing address:
  • Phone: 818-781-5225
  • Fax: 818-781-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: