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General NPI Number Information
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NPI Number | 1033752811
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Entity Type | Individual
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Provider Name | GRIGOR KOSOYAN
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Gender | Male
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 16301 NORDHOFF ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-3807
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Country | US
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Telephone | 213-709-7774
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Fax | 818-810-6919
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Provider Business Mailing Address
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Address Line | 343 PIONEER DR UNIT 105
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City | GLENDALE
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State | CA
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Zip | 91203-2738
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Country | US
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Telephone | 213-709-7774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 197609731
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License Number State | CA
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