Provider Demographics
NPI:1124162748
Name:ANN TUMBERIAN
Entity type:Organization
Organization Name:ANN TUMBERIAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMBERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-715-1173
Mailing Address - Street 1:20050 VANOWEN ST
Mailing Address - Street 2:UNIT I
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3943
Mailing Address - Country:US
Mailing Address - Phone:818-715-1173
Mailing Address - Fax:818-715-1176
Practice Address - Street 1:20050 VANOWEN ST
Practice Address - Street 2:UNIT I
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306-3943
Practice Address - Country:US
Practice Address - Phone:818-715-1173
Practice Address - Fax:818-715-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1274830001Medicare NSC