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General NPI Number Information
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NPI Number | 1952182180
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Entity Type | Individual
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Provider Name | KYLE MINASSIAN
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Gender | Male
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | PO BOX 3582
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City | GLENDALE
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State | CA
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Zip | 91221-3582
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Country | US
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Telephone | 323-818-7018
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 ALLEN AVE
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City | GLENDALE
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State | CA
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Zip | 91201-3469
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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 | 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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Taxonomy #2
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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