Provider Demographics
NPI:1619574522
Name:GYUZNALYAN, HARUTYUN
Entity Type:Individual
Prefix:
First Name:HARUTYUN
Middle Name:
Last Name:GYUZNALYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 N ALEXANDRIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5802
Mailing Address - Country:US
Mailing Address - Phone:323-333-7781
Mailing Address - Fax:
Practice Address - Street 1:8900 SEPULVEDA WESTWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3619
Practice Address - Country:US
Practice Address - Phone:310-258-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist