Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A113750 | CA |
NPI | 1003123670 |
---|---|
Provider Name | Srpouhi Gasparyan |
First Address | Los Angeles, CA 90027-5822 |
Second Address | Los Angeles, CA 90027-5822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2010 |
Last Update Date | 01/12/2021 |