| Laurel Grove Medical Center Inc | |
|
5437 Laurel Canyon Blvd Ste 107 Valley Village CA 91607-4615 | |
| (747) 204-8884 | |
| (213) 481-9944 |
| Full Name | Laurel Grove Medical Center Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5437 Laurel Canyon Blvd Ste 107, Valley Village, California |
| Authorized Official Name and Position | Narek Oganyan (MANAGER) |
| Authorized Official Contact | 7472048884 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Laurel Grove Medical Center Inc 5437 Laurel Canyon Blvd Ste 107 Valley Village CA 91607-4615 Ph: () - | Laurel Grove Medical Center Inc 5437 Laurel Canyon Blvd Ste 107 Valley Village CA 91607-4615 Ph: (747) 204-8884 |
| NPI Number | 1619525250 |
|---|---|
| Provider Enumeration Date | 08/27/2019 |
| Last Update Date | 06/07/2024 |
| Certification Date | 06/07/2024 |
| Medicare PECOS PAC ID | 3072057223 |
|---|---|
| Medicare Enrollment ID | O20240628002985 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619525250 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Primary |
| Provider Name | Lilit Yegiazaryan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770668345 PECOS PAC ID: 3072413632 Enrollment ID: I20040109001109 |
| Provider Name | Nune Hasmik Hovanisyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821629684 PECOS PAC ID: 9133556194 Enrollment ID: I20200304000543 |
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