Basic Information
| Provider Information | |||||||||
| NPI: | 1174769145 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOGHBATYAN | ||||||||
| FirstName: | LUSINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 N KENWOOD ST | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912064248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184506551 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 N STATE ST | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900331029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232267556 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2008 | ||||||||
| LastUpdateDate: | 12/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A105602 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.