Healthcare Provider Details

I. General information

NPI: 1215558341
Provider Name (Legal Business Name): LOS ANGELES FOOD ALLERGY INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BUENA VISTA ST # 310
BURBANK CA
91505-4569
US

IV. Provider business mailing address

201 S BUENA VISTA ST # 310
BURBANK CA
91505-4569
US

V. Phone/Fax

Practice location:
  • Phone: 818-561-4533
  • Fax: 818-561-4534
Mailing address:
  • Phone: 818-561-4533
  • Fax: 818-561-4534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: KRIKOR H MANOUKIAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 818-561-4533