Provider Demographics
NPI:1841981321
Name:NIKOGHOSYAN, LIANA (CEO)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:NIKOGHOSYAN
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17419 FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2211
Mailing Address - Country:US
Mailing Address - Phone:323-688-7070
Mailing Address - Fax:
Practice Address - Street 1:320 E STOCKER ST APT 210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1354
Practice Address - Country:US
Practice Address - Phone:559-578-4121
Practice Address - Fax:818-500-0982
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)