Provider Demographics
NPI:1528270303
Name:HARUTYUNYAN, LUSINE (PA)
Entity type:Individual
Prefix:MS
First Name:LUSINE
Middle Name:
Last Name:HARUTYUNYAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-248-8245
Mailing Address - Fax:310-248-8249
Practice Address - Street 1:8631 W 3RD ST STE 635E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5994
Practice Address - Country:US
Practice Address - Phone:310-248-8245
Practice Address - Fax:310-248-8249
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18776363AM0700X
CAPA 18776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18776OtherCALIFORNIA STATE LICENSE
CAPA 18776OtherSTATE LICENSE