Provider Demographics
NPI:1619525250
Name:LAUREL GROVE MEDICAL CENTER INC
Entity type:Organization
Organization Name:LAUREL GROVE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-204-8884
Mailing Address - Street 1:5437 LAUREL CANYON BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5437 LAUREL CANYON BLVD STE 107
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4615
Practice Address - Country:US
Practice Address - Phone:747-204-8884
Practice Address - Fax:213-481-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty