MEDICARE: LUCYNE MARTIROSYAN

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	332B00000X	Durable Medical Equipment & Medical Supplies	G6508733	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538631957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCYNE MARTIROSYAN

Provider Business Mailing Address
First Line	:	7450 W CHEYENNE AVE STE 104B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7409
Country	:	US
Telephone Number	:	702-778-2090
Fax Number	:	702-823-2448

Provider Business Practice Location Address
First Line	:	7450 W CHEYENNE AVE STE 104B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7409
Country	:	US
Telephone Number	:	702-778-2090
Fax Number	:	702-823-2448

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

Provider Enumeration Date	:	12/24/2018
Last Update Date	:	12/24/2018

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Directions to “ LUCYNE MARTIROSYAN ” Practice Location

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