Healthcare Provider Details

I. General information

NPI: 1245107903
Provider Name (Legal Business Name): ARTUR VAHRAMYAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20152 ACRE ST
WINNETKA CA
91306-1102
US

IV. Provider business mailing address

20152 ACRE ST
WINNETKA CA
91306-1102
US

V. Phone/Fax

Practice location:
  • Phone: 747-243-7965
  • Fax:
Mailing address:
  • Phone: 747-243-7965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number197610784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: