Provider Demographics
NPI: | 1619525250 |
---|---|
Name: | LAUREL GROVE MEDICAL CENTER |
Entity Type: | Organization |
Organization Name: | LAUREL GROVE MEDICAL CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NAREK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | OGANYAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 747-204-8884 |
Mailing Address - Street 1: | 6260 LAUREL CANYON BLVD STE 103 |
Mailing Address - Street 2: | |
Mailing Address - City: | NORTH HOLLYWOOD |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91606-3238 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6260 LAUREL CANYON BLVD STE 103 |
Practice Address - Street 2: | |
Practice Address - City: | NORTH HOLLYWOOD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91606-3238 |
Practice Address - Country: | US |
Practice Address - Phone: | 747-204-8884 |
Practice Address - Fax: | 213-481-9944 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-08-27 |
Last Update Date: | 2019-08-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |