MEDICARE: ALFRET MORADIAN M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A104840	CA

General Provider Information

NPI Number	:	1336303718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFRET MORADIAN M.D

Provider Business Mailing Address
First Line	:	1101 N PACIFIC AVE STE 102
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-4311
Country	:	US
Telephone Number	:	818-244-9929
Fax Number	:	818-244-9922

Provider Business Practice Location Address
First Line	:	1101 N PACIFIC AVE STE 102
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-4311
Country	:	US
Telephone Number	:	818-244-9929
Fax Number	:	818-244-9922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	09/23/2011

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