Provider Demographics
NPI:1588913107
Name:AMBARTSUMYAN, ARTUR (PA)
Entity type:Individual
Prefix:
First Name:ARTUR
Middle Name:
Last Name:AMBARTSUMYAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E HARDY ST
Mailing Address - Street 2:STE 407
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4064
Mailing Address - Country:US
Mailing Address - Phone:310-673-7724
Mailing Address - Fax:310-673-5895
Practice Address - Street 1:8444 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1914
Practice Address - Country:US
Practice Address - Phone:310-342-7000
Practice Address - Fax:310-342-7666
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21942363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical