Provider Demographics
NPI:1578343885
Name:MARTIROSYAN, SONA
Entity Type:Individual
Prefix:
First Name:SONA
Middle Name:
Last Name:MARTIROSYAN
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 1:10822 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4011
Mailing Address - Country:US
Mailing Address - Phone:774-444-4104
Mailing Address - Fax:
Practice Address - Street 1:10822 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4011
Practice Address - Country:US
Practice Address - Phone:774-444-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1093831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice