Basic Information
| Provider Information | |||||||||
| NPI: | 1124470141 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARGSYAN | ||||||||
| FirstName: | MARINA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 CARPENTER AVE | ||||||||
| Address2: | APT 204 | ||||||||
| City: | VALLEY VILLAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916072264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189134056 | ||||||||
| FaxNumber: | 8187609434 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 N VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900276098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239134892 | ||||||||
| FaxNumber: | 6264476057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA53889 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.