MEDICARE: LUSINE AZATIAN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95010943	CA

General Provider Information

NPI Number	:	1376185090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUSINE AZATIAN

Provider Business Mailing Address
First Line	:	11204 PASO ROBLES AVE
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4150
Country	:	US
Telephone Number	:	818-813-4241
Fax Number	:

Provider Business Practice Location Address
First Line	:	517 E WILSON AVE STE 103B
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4376
Country	:	US
Telephone Number	:	747-215-6068
Fax Number	:

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

Provider Enumeration Date	:	10/15/2019
Last Update Date	:	10/15/2019

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Directions to “ LUSINE AZATIAN ” Practice Location

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