Provider Demographics
NPI:1932630621
Name:HARUTYUNYAN, NIKA MANIK (MD)
Entity Type:Individual
Prefix:
First Name:NIKA
Middle Name:MANIK
Last Name:HARUTYUNYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANIK
Other - Middle Name:
Other - Last Name:HARUTYUNYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:757 WESTWOOD PLZ STE 7501
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7417
Mailing Address - Country:US
Mailing Address - Phone:310-267-9875
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLAZA SUITE 7501
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7417
Practice Address - Country:US
Practice Address - Phone:310-267-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA160412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine