Provider Demographics
NPI:1619988714
Name:MANASARYAN, RUZANNA
Entity Type:Individual
Prefix:
First Name:RUZANNA
Middle Name:
Last Name:MANASARYAN
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 1:5112 HOLLYWOOD BLVD
Mailing Address - Street 2:#103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:323-906-9991
Mailing Address - Fax:323-906-9998
Practice Address - Street 1:5112 HOLLYWOOD BLVD
Practice Address - Street 2:#103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-906-9991
Practice Address - Fax:323-906-9992
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3862440001Medicare NSC