Basic Information
Provider Information
NPI: 1225252596
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AGOPIAN
FirstName: LUCIE
MiddleName: G.
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6953 SUNNYBRAE AVE
Address2:  
City: WINNETKA
State: CA
PostalCode: 913063431
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 5601 DE SOTO AVE
Address2:  
City: WOODLAND HILLS
State: CA
PostalCode: 913676701
CountryCode: US
TelephoneNumber: 8187192930
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/11/2007
LastUpdateDate: 12/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800X24939CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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