MEDICARE: NUNE GALSTYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D7195317	OTHER	CA	DRIVERS LICENSE

General Provider Information

NPI Number	:	1356930192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NUNE GALSTYAN

Provider Business Mailing Address
First Line	:	2252 BEVERLY BLVD STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2246
Country	:	US
Telephone Number	:	213-674-7424
Fax Number	:	213-674-7524

Provider Business Practice Location Address
First Line	:	2252 BEVERLY BLVD STE 103
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2246
Country	:	US
Telephone Number	:	213-674-7424
Fax Number	:	213-674-7524

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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Directions to “ NUNE GALSTYAN ” Practice Location

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