Provider Demographics
NPI:1477626638
Name:LA CIENEGA ENTERPRISES INC.
Entity Type:Organization
Organization Name:LA CIENEGA ENTERPRISES INC.
Other - Org Name:LA CIENEGA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARAKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAKELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-786-0590
Mailing Address - Street 1:7215 KESTER AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2112
Mailing Address - Country:US
Mailing Address - Phone:818-786-0590
Mailing Address - Fax:818-786-0563
Practice Address - Street 1:7215 KESTER AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2112
Practice Address - Country:US
Practice Address - Phone:818-786-0590
Practice Address - Fax:818-786-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103535332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4415950001Medicare NSC