Healthcare Provider Details

I. General information

NPI: 1811189822
Provider Name (Legal Business Name): VICTOR A. GABRIELIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 W HUNTINGTON DR STE 401
ARCADIA CA
91007-3493
US

IV. Provider business mailing address

3452 E FOOTHILL BLVD SUITE 130
PASADENA CA
91107-3142
US

V. Phone/Fax

Practice location:
  • Phone: 626-915-4700
  • Fax: 626-214-7814
Mailing address:
  • Phone: 626-793-2885
  • Fax: 626-796-9648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA101256
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA101256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: