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General NPI Number Information
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NPI Number | 1538631957
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Entity Type | Individual
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Provider Name | LUCYNE MARTIROSYAN
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Gender | Female
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Dates
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Enumeration Date | 12/24/2018
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Last Update Date | 12/24/2018
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Provider Practice Location Address
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Address Line | 7450 W CHEYENNE AVE STE 104B
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City | LAS VEGAS
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State | NV
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Zip | 89129-7409
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Country | US
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Telephone | 702-778-2090
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Fax | 702-823-2448
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Provider Business Mailing Address
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Address Line | 7450 W CHEYENNE AVE STE 104B
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City | LAS VEGAS
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State | NV
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Zip | 89129-7409
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Country | US
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Telephone | 702-778-2090
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Fax | 702-823-2448
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | G6508733
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License Number State | NV
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