Provider Demographics
NPI:1124267653
Name:SARGSYAN, KARINE
Entity type:Individual
Prefix:
First Name:KARINE
Middle Name:
Last Name:SARGSYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEVON
Other - Middle Name:
Other - Last Name:SARGSYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 W ELM AVE APT S
Mailing Address - Street 2:S
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-3035
Mailing Address - Country:US
Mailing Address - Phone:818-823-6717
Mailing Address - Fax:310-691-8877
Practice Address - Street 1:221 W ELM AVE APT S
Practice Address - Street 2:S
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-3035
Practice Address - Country:US
Practice Address - Phone:818-823-6717
Practice Address - Fax:310-691-8877
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB4174885347C00000X
CAA4680527347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle