Healthcare Provider Details

I. General information

NPI: 1457800757
Provider Name (Legal Business Name): IZABELLA ABRAMYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 10/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 SEPULVEDA BLVD
VAN NUYS CA
91411-2503
US

IV. Provider business mailing address

6100 SEPULVEDA BLVD
VAN NUYS CA
91411-2503
US

V. Phone/Fax

Practice location:
  • Phone: 818-989-5158
  • Fax: 818-373-5126
Mailing address:
  • Phone: 818-989-5158
  • Fax: 818-373-5126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69380
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number69380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: