MEDICARE: PAITSAR ZHAMKOCHYAN MS, CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SP15124	CA

General Provider Information

NPI Number	:	1992017297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAITSAR ZHAMKOCHYAN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	12435 NUGENT DR.
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344
Country	:	US
Telephone Number	:	818-522-5651
Fax Number	:

Provider Business Practice Location Address
First Line	:	12435 NUGENT DR
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-1534
Country	:	US
Telephone Number	:	818-522-5651
Fax Number	:

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

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	10/10/2014

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