Provider Demographics
NPI:1023051646
Name:SHAGRAMANOVA, NATALYA
Entity type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:SHAGRAMANOVA
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 1:1545 N VERDUGO RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2862
Mailing Address - Country:US
Mailing Address - Phone:818-662-5104
Mailing Address - Fax:818-662-5063
Practice Address - Street 1:1545 N VERDUGO RD
Practice Address - Street 2:SUITE 112
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-2862
Practice Address - Country:US
Practice Address - Phone:818-662-5104
Practice Address - Fax:818-662-5063
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
CA542041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic