=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992039218
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARLET AGAZARYAN D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2009
-----------------------------------------------------
Last Update Date | 05/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11682 ATLANTIC AVE
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90262-3832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-537-7600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11682 ATLANTIC AVE
-----------------------------------------------------
City | LYNWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90262-3832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-537-7600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC31372
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------