Provider Demographics
NPI:1891576211
Name:PROSPERITY HEALTH GROUP
Entity Type:Organization
Organization Name:PROSPERITY HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARAPET
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRAKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:213-444-9092
Mailing Address - Street 1:9018 BALBOA BLVD # 281
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12444 VICTORY BLVD # 308
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3199
Practice Address - Country:US
Practice Address - Phone:213-444-9092
Practice Address - Fax:213-444-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service