Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 95018666 | CA |
NPI | 1124783014 |
---|---|
Provider Name | Lusine Antinyan |
First Address | North Hollywood, CA 91605-1006 |
Second Address | Studio City, CA 91604-3300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2021 |
Last Update Date | 04/11/2021 |