=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619525250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAUREL GROVE MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2019
-----------------------------------------------------
Last Update Date | 06/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5437 LAUREL CANYON BLVD STE 107
-----------------------------------------------------
City | VALLEY VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91607-4615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-204-8884
-----------------------------------------------------
Fax | 213-481-9944
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5437 LAUREL CANYON BLVD STE 107
-----------------------------------------------------
City | VALLEY VILLAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91607-4615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | NAREK OGANYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 747-204-8884
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084B0040X
-----------------------------------------------------
Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------