Provider Demographics
NPI:1104248400
Name:MINASYAN, SIRAK
Entity type:Individual
Prefix:
First Name:SIRAK
Middle Name:
Last Name:MINASYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 NESTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4542
Mailing Address - Country:US
Mailing Address - Phone:747-222-9222
Mailing Address - Fax:559-435-9990
Practice Address - Street 1:6840 NESTLE AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4542
Practice Address - Country:US
Practice Address - Phone:747-222-9222
Practice Address - Fax:559-435-9990
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities