Provider Demographics
NPI:1629486394
Name:NAZARETYAN, LUSINE
Entity Type:Individual
Prefix:
First Name:LUSINE
Middle Name:
Last Name:NAZARETYAN
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 1:1740 HUNTINGTON DR STE 305
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3842
Mailing Address - Country:US
Mailing Address - Phone:626-531-6999
Mailing Address - Fax:
Practice Address - Street 1:1740 HUNTINGTON DR STE 305
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3842
Practice Address - Country:US
Practice Address - Phone:626-531-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator