Provider Demographics
NPI:1730637299
Name:GHAZARYAN, GARNIK GARY
Entity Type:Individual
Prefix:
First Name:GARNIK
Middle Name:GARY
Last Name:GHAZARYAN
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 1:11107 ARMINTA ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4473
Mailing Address - Country:US
Mailing Address - Phone:323-491-0607
Mailing Address - Fax:
Practice Address - Street 1:765 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1181
Practice Address - Country:US
Practice Address - Phone:213-580-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager