Provider Demographics
NPI:1942743075
Name:SAGRYAN, MARI
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:SAGRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:
Other - Last Name:SAGRYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:6801 COLDWATER CANYON AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-5162
Mailing Address - Country:US
Mailing Address - Phone:818-763-1718
Mailing Address - Fax:818-763-7231
Practice Address - Street 1:6801 COLDWATER CANYON AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5162
Practice Address - Country:US
Practice Address - Phone:818-763-1718
Practice Address - Fax:818-763-7231
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95103506163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse