MEDICARE: SONIA H YACOBIAN 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	174400000X	Specialist	A52602	CA

General Provider Information

NPI Number	:	1881641488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA H YACOBIAN M.D.

Provider Business Mailing Address
First Line	:	815 E COLORADO ST STE 200
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1298
Country	:	US
Telephone Number	:	818-244-5444
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 E COLORADO ST STE 200
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1298
Country	:	US
Telephone Number	:	818-244-5444
Fax Number	:

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	07/08/2007

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