Provider Demographics
NPI:1942401872
Name:KARAGIOZOVA, LIANA
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:KARAGIOZOVA
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 1:332 RIVERDALE DR
Mailing Address - Street 2:APT 3
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4621
Mailing Address - Country:US
Mailing Address - Phone:818-269-5009
Mailing Address - Fax:
Practice Address - Street 1:332 RIVERDALE DR
Practice Address - Street 2:APT 3
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4621
Practice Address - Country:US
Practice Address - Phone:818-269-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68382183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician