Provider Demographics
NPI:1124470141
Name:SARGSYAN, MARINA (PA-C)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SARGSYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 CARPENTER AVE
Mailing Address - Street 2:APT 204
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2264
Mailing Address - Country:US
Mailing Address - Phone:818-913-4056
Mailing Address - Fax:818-760-9434
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6098
Practice Address - Country:US
Practice Address - Phone:323-913-4892
Practice Address - Fax:626-447-6057
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA53889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant