Provider Demographics
NPI:1952560732
Name:POGHOSYAN, LIANA
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:POGHOSYAN
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 1:519 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1110
Mailing Address - Country:US
Mailing Address - Phone:818-409-3020
Mailing Address - Fax:
Practice Address - Street 1:401 S GLENOAKS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2707
Practice Address - Country:US
Practice Address - Phone:818-748-1740
Practice Address - Fax:818-748-1741
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine