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General NPI Number Information
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NPI Number | 1801479464
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Entity Type | Individual
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Provider Name | LYOLYA HOVHANNISYAN MD, MSC
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Gender | Female
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 1812 VERDUGO BLVD
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City | GLENDALE
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State | CA
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Zip | 91208-1407
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Country | US
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Telephone | 626-457-6601
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31309
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City | LOS ANGELES
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State | CA
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Zip | 90031-0309
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Country | US
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Telephone | 626-457-6601
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A183049
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License Number State | CA
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