Provider Demographics
NPI:1518663988
Name:PINK CHANCES MED CORPORATION
Entity Type:Organization
Organization Name:PINK CHANCES MED CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SILVA
Authorized Official - Middle Name:
Authorized Official - Last Name:DZHIGARSZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-930-1222
Mailing Address - Street 1:7341 FOOTHILL BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2795
Mailing Address - Country:US
Mailing Address - Phone:747-955-9855
Mailing Address - Fax:
Practice Address - Street 1:7341 FOOTHILL BLVD STE 204
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2795
Practice Address - Country:US
Practice Address - Phone:747-955-9855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone