MEDICARE: SONA BAGHDASARYAN

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1427606862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONA BAGHDASARYAN

Provider Business Mailing Address
First Line	:	6033 HAZELHURST PL APT 20
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4850
Country	:	US
Telephone Number	:	818-370-4410
Fax Number	:

Provider Business Practice Location Address
First Line	:	6033 HAZELHURST PL APT 20
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4850
Country	:	US
Telephone Number	:	818-370-4410
Fax Number	:

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

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	08/16/2020

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Directions to “ SONA BAGHDASARYAN ” Practice Location

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