Individual
NANA AVETISYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13716 SHERMAN WAY, VAN NUYS, CA 91405-2626
(818) 744-5102
Mailing address
7015 FULTON AVE APT 5, NORTH HOLLYWOOD, CA 91605-4424
(818) 744-5102
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA94891
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RDA94891
—
CA
Enumeration date
09/02/2020
Last updated
09/02/2020
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