Provider Demographics
NPI:1730108929
Name:HOLY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:HOLY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAKOP
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-481-9900
Mailing Address - Street 1:6330 LAUREL CANYON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3213
Mailing Address - Country:US
Mailing Address - Phone:213-481-9900
Mailing Address - Fax:213-481-9944
Practice Address - Street 1:111 N. GLENDALE BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026
Practice Address - Country:US
Practice Address - Phone:213-481-9900
Practice Address - Fax:213-481-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83140261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY23274Medicare UPIN