Provider Demographics
NPI:1962248351
Name:HARUTYUNYAN, SHUSHAN
Entity type:Individual
Prefix:MRS
First Name:SHUSHAN
Middle Name:
Last Name:HARUTYUNYAN
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 1:7700 BABCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2213
Mailing Address - Country:US
Mailing Address - Phone:747-248-9357
Mailing Address - Fax:
Practice Address - Street 1:14624 SHERMAN WAY STE 508
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2289
Practice Address - Country:US
Practice Address - Phone:818-374-6901
Practice Address - Fax:818-374-6908
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000XOtherSFVCMHC