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General NPI Number Information
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NPI Number | 1770032690
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Entity Type | Individual
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Provider Name | ASTGHIK HARUTYUNYAN PT
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Gender | Female
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 3699 WILSHIRE BLVE
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City | LOS ANGELES
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State | CA
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Zip | 90010
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Country | US
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Telephone | 323-445-5659
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Fax |
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Provider Business Mailing Address
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Address Line | 6618 MAMMOTH AVE
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City | VAN NUYS
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State | CA
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Zip | 91405-4812
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Country | US
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Telephone |
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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 | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 39559
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License Number State | CA
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