Individual
KYLE MINASSIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
PO BOX 3582, GLENDALE, CA 91221-3582
(323) 818-7018
Mailing address
1020 ALLEN AVE, GLENDALE, CA 91201-3469
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
315D00000X
Inpatient Hospice
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
932739273
SKILLED NURSING FACILITY
CA
Enumeration date
10/12/2023
Last updated
01/29/2025
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