Provider Demographics
NPI:1518105717
Name:OGANISYAN, NONA N
Entity Type:Individual
Prefix:
First Name:NONA
Middle Name:N
Last Name:OGANISYAN
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 1:1317 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1119
Mailing Address - Country:US
Mailing Address - Phone:818-455-9722
Mailing Address - Fax:818-500-0223
Practice Address - Street 1:635 W COLORADO ST
Practice Address - Street 2:SUITE 104
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1175
Practice Address - Country:US
Practice Address - Phone:818-455-9722
Practice Address - Fax:818-500-0223
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health