Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 46262 | CA |
NPI | 1538434196 |
---|---|
Provider Name | Ms. Ripsik Gukasyan |
First Address | Glendale, CA 91206-4005 |
Second Address | Los Angeles, CA 90089-0641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2012 |
Last Update Date | 15/03/2012 |