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General NPI Number Information
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NPI Number | 1376185090
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Entity Type | Individual
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Provider Name | LUSINE AZATIAN
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Gender | Female
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 517 E WILSON AVE STE 103B
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City | GLENDALE
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State | CA
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Zip | 91206-4376
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Country | US
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Telephone | 747-215-6068
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Fax |
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Provider Business Mailing Address
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Address Line | 11204 PASO ROBLES AVE
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City | GRANADA HILLS
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State | CA
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Zip | 91344-4150
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Country | US
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Telephone | 818-813-4241
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95010943
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License Number State | CA
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