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General NPI Number Information
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NPI Number | 1669965349
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Entity Type | Organization
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Legal Business Name | PETIT AVE INC.
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 6719 QUAKERTOWN AVE
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City | WINNETKA
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State | CA
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Zip | 91306-4336
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Country | US
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Telephone | 818-945-4374
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Fax | 818-435-3079
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Provider Business Mailing Address
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Address Line | 6719 QUAKERTOWN AVE
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City | WINNETKA
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State | CA
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Zip | 91306-4336
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Country | US
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Telephone | 818-945-4374
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Fax | 818-435-3079
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Authorized Official
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Title or Position | CEO
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Name | MR. EDGAR GHAZARYAN
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Credential | RRT, RCP
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Telephone | 818-945-4374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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