Provider Demographics
NPI:1801836226
Name:MARTIROSYAN, SHUSHANIK
Entity Type:Individual
Prefix:
First Name:SHUSHANIK
Middle Name:
Last Name:MARTIROSYAN
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 1:14621 TITUS ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4908
Mailing Address - Country:US
Mailing Address - Phone:818-781-5225
Mailing Address - Fax:818-781-5378
Practice Address - Street 1:14621 TITUS ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91402-4908
Practice Address - Country:US
Practice Address - Phone:818-781-5225
Practice Address - Fax:818-781-5378
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor