Provider Demographics
NPI:1396872818
Name:TOROSYAN, AGAVNI
Entity type:Individual
Prefix:
First Name:AGAVNI
Middle Name:
Last Name:TOROSYAN
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 1:610 N CENTRAL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1421
Mailing Address - Country:US
Mailing Address - Phone:818-955-8935
Mailing Address - Fax:818-241-2294
Practice Address - Street 1:610 N CENTRAL AVE STE 104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1421
Practice Address - Country:US
Practice Address - Phone:818-955-8935
Practice Address - Fax:818-241-2294
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTN01128F343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)