Provider Demographics
NPI:1821799164
Name:LIFE MEDICAL PRACTITIONERS
Entity Type:Organization
Organization Name:LIFE MEDICAL PRACTITIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-823-6717
Mailing Address - Street 1:4776 ALLIED RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2412
Mailing Address - Country:US
Mailing Address - Phone:818-823-6717
Mailing Address - Fax:
Practice Address - Street 1:4776 ALLIED RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2412
Practice Address - Country:US
Practice Address - Phone:818-823-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty