Provider Demographics
NPI:1760061345
Name:SARUKHANIAN, NATALIE MARIAM
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIAM
Last Name:SARUKHANIAN
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 1:328 MILFORD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2031
Mailing Address - Country:US
Mailing Address - Phone:818-726-7141
Mailing Address - Fax:
Practice Address - Street 1:450 N ROXBURY DR FL 3
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4238
Practice Address - Country:US
Practice Address - Phone:310-651-2337
Practice Address - Fax:310-453-2519
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34895207W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology