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General NPI Number Information
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NPI Number | 1790249852
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Entity Type | Organization
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Legal Business Name | SUSANNA MARGARYAN MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 1511 W. GLENDALE AVE.
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City | GLENDALE
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State | CA
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Zip | 91201
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Country | US
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Telephone | 805-991-6638
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Fax |
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Provider Business Mailing Address
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Address Line | 3159 DWIGHT AVE
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City | CAMARILLO
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State | CA
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Zip | 93010-3705
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Country | US
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Telephone | 805-991-6638
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SUSANNA MARGARYAN
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Credential | MD
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Telephone | 805-991-6638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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