Provider Demographics
NPI:1235534306
Name:AMBARTSUMIAN, LENA
Entity Type:Individual
Prefix:MRS
First Name:LENA
Middle Name:
Last Name:AMBARTSUMIAN
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 1:23501 CINEMA DR STE 210
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5430
Mailing Address - Country:US
Mailing Address - Phone:661-288-4800
Mailing Address - Fax:661-254-2940
Practice Address - Street 1:23501 CINEMA DR STE 210
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5430
Practice Address - Country:US
Practice Address - Phone:661-288-4800
Practice Address - Fax:661-254-2940
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW2983PMedicare PIN