Healthcare Provider Details

I. General information

NPI: 1093765836
Provider Name (Legal Business Name): MS. LUSINE OGANDGANYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14640 VICTORY BLVD STE 213
VAN NUYS CA
91411-4197
US

IV. Provider business mailing address

14640 VICTORY BLVD STE 213
VAN NUYS CA
91411-4197
US

V. Phone/Fax

Practice location:
  • Phone: 818-786-6741
  • Fax: 818-786-6974
Mailing address:
  • Phone: 818-786-6741
  • Fax: 818-786-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License NumberTG350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: