Provider Demographics
NPI:1073902060
Name:HOVHANNISYAN, SYUZANNA
Entity Type:Individual
Prefix:
First Name:SYUZANNA
Middle Name:
Last Name:HOVHANNISYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 W 200 S APT 19
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1313
Mailing Address - Country:US
Mailing Address - Phone:801-819-2333
Mailing Address - Fax:
Practice Address - Street 1:274 W 200 S APT 19
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1313
Practice Address - Country:US
Practice Address - Phone:801-819-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter