Provider Demographics
NPI:1194347807
Name:KHACHATRYAN, MARINE
Entity type:Individual
Prefix:
First Name:MARINE
Middle Name:
Last Name:KHACHATRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 N KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5827
Mailing Address - Country:US
Mailing Address - Phone:323-552-3300
Mailing Address - Fax:323-460-6000
Practice Address - Street 1:5300 SANTA MONICA BLVD STE 311
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1259
Practice Address - Country:US
Practice Address - Phone:323-715-0771
Practice Address - Fax:323-460-6000
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice