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General NPI Number Information
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NPI Number | 1407086952
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Entity Type | Individual
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Provider Name | LUIZA NERSISYAN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 2211 W MAGNOLIA BLVD STE 220
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City | BURBANK
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State | CA
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Zip | 91506-1754
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Country | US
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Telephone | 818-517-4047
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Fax |
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Provider Business Mailing Address
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Address Line | 1832 N BEL AIRE DR
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City | BURBANK
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State | CA
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Zip | 91504-1907
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Country | US
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Telephone | 818-517-4047
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 58348
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License Number State | CA
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