Provider Demographics
NPI:1568936466
Name:GHAZARYAN, LILIT (OTA)
Entity Type:Individual
Prefix:MS
First Name:LILIT
Middle Name:
Last Name:GHAZARYAN
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12814 VICTORY BLVD # 122
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3013
Mailing Address - Country:US
Mailing Address - Phone:707-880-4488
Mailing Address - Fax:
Practice Address - Street 1:12814 VICTORY BLVD # 122
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3013
Practice Address - Country:US
Practice Address - Phone:707-880-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2897224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant