| Details | Last Recertification Date | Update | Recertification | 2/15/2024 7:12:13 PM | 3/3/2025 4:42:59 PM | 3/3/2025 4:42 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Tatulian, Karmen S.
MEDICAL DIRECTOR
CA1557A
1818810300-8188103500 | Tatulian, Karmen S.
MEDICAL DIRECTOR
CA1557A
8188103500 | 2/21/2025 1:49 PM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2023 4:16:53 PM | 2/15/2024 7:12:13 PM | 2/15/2024 7:12 PM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2022 7:35:30 PM | 2/16/2023 4:16:53 PM | 2/16/2023 4:16 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Tatulian, Karmen TATULIAN,
MEDICAL DIRECTOR
el proyecto del barrio,inc
8188103500-8188103500 | Tatulian, Karmen S.
MEDICAL DIRECTOR
CA1557A
1818810300-8188103500 | 2/13/2023 8:06 AM |
| Details | Last Recertification Date | Update | Recertification | 2/22/2021 4:59:42 PM | 2/16/2022 7:35:30 PM | 2/16/2022 7:35 PM |
| Contacts | Primary Contact | Update | New Registration | Tatulian, Karmen
MEDICAL DIRECTOR
el proyecto del barrio,inc
8188103500 | Tatulian, Karmen TATULIAN,
MEDICAL DIRECTOR
el proyecto del barrio,inc
8188103500-8188103500 | 4/15/2021 2:38 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1093181448 ( ) | | 2/22/2021 4:59 PM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2020 4:15:47 PM | 2/22/2021 4:59:42 PM | 2/22/2021 4:59 PM |
| Addresses | Billing Address | Update | Recertification | El Proyecto del Barrio,Inc
8902 Woodman Ave
Arleta, CA 91331 | El Proyecto del Barrio,Inc
8932 Woodman Ave
Arleta, CA 91331 | 2/14/2020 4:15 PM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2019 2:12:34 PM | 2/14/2020 4:15:47 PM | 2/14/2020 4:15 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | SANCHEZ, CORINNE
PRESIDENT/CEO
El Proyecto del barrio,inc
8188307133-2247 | SANCHEZ, CORINNE
PRESIDENT/CEO
El Proyecto del barrio,inc
8188103500 | 2/14/2020 4:14 PM |
| Contacts | Signed By | Update | Profile Change Request | SANCHEZ, CORINNE
PRESIDENT/CEO
El Proyecto del barrio,inc
8188307133-2247 | SANCHEZ, CORINNE
PRESIDENT/CEO
El Proyecto del barrio,inc
8188103500 | 2/14/2020 4:14 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Tatulian, Karmen
MEDICAL DIRECTOR
el proyecto del barrio,inc
8188307133-2258 | Tatulian, Karmen
MEDICAL DIRECTOR
el proyecto del barrio,inc
8188103500 | 2/5/2020 2:09 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2018 12:48:01 PM | 2/12/2019 2:12:34 PM | 2/12/2019 2:12 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1093181448 | 7/23/2018 10:15 PM |
| Details | Is Authorizing Official EHB Data | Update | Change Request | False | | 7/23/2018 10:15 PM |
| Details | Last Recertification Date | Update | Recertification | 1/25/2017 12:00:00 AM | 2/9/2018 12:48:01 PM | 2/9/2018 12:48 PM |
| Contacts | Authorizing Official | Update | | SANCHEZ, CORINNE
PRESIDENT/CEO
8188307133-2247 | SANCHEZ, CORINNE
PRESIDENT/CEO
El Proyecto del barrio,inc
8188307133-2247 | 10/3/2017 5:53 PM |
| Contacts | Signed By | Update | | SANCHEZ, CORINNE
PRESIDENT/CEO
8188307133-2247 | SANCHEZ, CORINNE
PRESIDENT/CEO
El Proyecto del barrio,inc
8188307133-2247 | 10/3/2017 5:53 PM |
| Contacts | Primary Contact | Update | | Tatulian, Karmen
MEDICAL DIRECTOR
8188307133-2258 | Tatulian, Karmen
MEDICAL DIRECTOR
el proyecto del barrio,inc
8188307133-2258 | 10/2/2017 1:54 PM |
| Contacts | Authorizing Official | Insert | | | SANCHEZ, CORINNE
PRESIDENT/CEO
8188307133-2247 | 7/18/2017 1:53 PM |
| Contacts | Signed By | Insert | | | SANCHEZ, CORINNE
PRESIDENT/CEO
8188307133-2247 | 7/18/2017 1:53 PM |
| Contacts | Primary Contact | Insert | | | Tatulian, Karmen
MEDICAL DIRECTOR
8188307133-2258 | 1/25/2017 1:55 PM |
| Addresses | Main Address | Insert | | |
18250 Roscoe Blvd. Suite 200
Northridge, CA 91325 | 1/25/2017 1:21 PM |
| Details | Last Recertification Date | Update | | | 1/25/2017 12:00:00 AM | 1/25/2017 1:21 PM |
| Addresses | Billing Address | Insert | | | El Proyecto del Barrio,Inc
8902 Woodman Ave
Arleta, CA 91331 | 2/10/2016 5:14 PM |
| Dates | Participating Approval Date | Update | | | 2/10/2016 12:00:00 AM | 2/10/2016 5:14 PM |
| Details | State | Update | | Pending | Active | 2/10/2016 5:14 PM |
| Dates | Start Date | Update | | | 4/1/2016 12:00:00 AM | 2/10/2016 5:14 PM |
| Details | 340B ID | Update | | ONLINE_REG_58091 | CH09162J | 1/20/2016 9:29 AM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_58091 | 1/14/2016 7:22 PM |
| Details | Last Recertification Date | Insert | | | | 1/14/2016 7:22 PM |
| Details | Grant Number | Insert | | | H80CS06647 | 1/14/2016 7:22 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/14/2016 7:22 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 1/14/2016 7:22 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/14/2016 7:22 PM |
| Details | Medicare Provider Number | Insert | | | | 1/14/2016 7:22 PM |
| Details | Entity Name | Insert | | | EL PROYECTO DEL BARRIO, INC | 1/14/2016 7:22 PM |
| Details | Program Code | Insert | | | CH | 1/14/2016 7:22 PM |
| Details | Entity Subname | Insert | | | EL PROYECTO DEL BARRIO--NORTHRIDGE COMMUNITY CLINIC | 1/14/2016 7:22 PM |
| Dates | Participating Approval Date | Insert | | | | 1/14/2016 7:22 PM |
| Details | State | Insert | | | Pending | 1/14/2016 7:22 PM |
| Dates | Registration Date | Insert | | | 1/14/2016 12:00:00 AM | 1/14/2016 7:22 PM |
| Dates | Signed By Date | Insert | | | 1/14/2016 12:00:00 AM | 1/14/2016 7:22 PM |
| Dates | Start Date | Insert | | | | 1/14/2016 7:22 PM |
| Terminations | Termination Comments | Insert | | | | 1/14/2016 7:22 PM |
| Terminations | Termination Date | Insert | | | | 1/14/2016 7:22 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/14/2016 7:22 PM |
| Terminations | Termination Reason | Insert | | | | 1/14/2016 7:22 PM |