Provider Demographics
NPI:1730631656
Name:HARUTYUNYAN, NAREK
Entity type:Individual
Prefix:
First Name:NAREK
Middle Name:
Last Name:HARUTYUNYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 ALOHA ST
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2205
Mailing Address - Country:US
Mailing Address - Phone:213-399-9209
Mailing Address - Fax:
Practice Address - Street 1:6051 HOLLYWOOD BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-5496
Practice Address - Country:US
Practice Address - Phone:213-399-9209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver