Provider Demographics
NPI:1265784532
Name:LAZIK DER SARKISSIAN, MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LAZIK DER SARKISSIAN, MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAZIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DER SARKISSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-243-9463
Mailing Address - Street 1:540 N CENTRAL AVE
Mailing Address - Street 2:205
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1916
Mailing Address - Country:US
Mailing Address - Phone:818-243-9463
Mailing Address - Fax:818-243-5416
Practice Address - Street 1:540 N CENTRAL AVE
Practice Address - Street 2:205
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1916
Practice Address - Country:US
Practice Address - Phone:818-243-9463
Practice Address - Fax:818-243-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO41167207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41167AMedicare PIN
CAE71666Medicare UPIN