Provider Demographics
NPI:1154121382
Name:MANSOORIAN, LADAN LUCY
Entity type:Individual
Prefix:
First Name:LADAN
Middle Name:LUCY
Last Name:MANSOORIAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22514 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3711
Mailing Address - Country:US
Mailing Address - Phone:818-312-7775
Mailing Address - Fax:
Practice Address - Street 1:22514 HAYNES ST
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3711
Practice Address - Country:US
Practice Address - Phone:818-312-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist