Provider Demographics
NPI:1053143719
Name:MANUKIAN, MINELI
Entity type:Individual
Prefix:
First Name:MINELI
Middle Name:
Last Name:MANUKIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18627 ARMINTA ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1836
Mailing Address - Country:US
Mailing Address - Phone:818-600-8179
Mailing Address - Fax:
Practice Address - Street 1:18627 ARMINTA ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1836
Practice Address - Country:US
Practice Address - Phone:818-600-8179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197610477310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility