Provider Demographics
NPI:1295935526
Name:SOGOMONIAN, LIDIA ANN (LVN)
Entity type:Individual
Prefix:MISS
First Name:LIDIA
Middle Name:ANN
Last Name:SOGOMONIAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5328 GILLESPIE ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-0231
Mailing Address - Country:US
Mailing Address - Phone:805-665-7423
Mailing Address - Fax:
Practice Address - Street 1:5328 GILLESPIE ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-0231
Practice Address - Country:US
Practice Address - Phone:805-665-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN193259164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse