Healthcare Provider Details

I. General information

NPI: 1508279399
Provider Name (Legal Business Name): GAREN GHARAKHANIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 KING AVE
CORCORAN CA
93212-9611
US

IV. Provider business mailing address

4001 KING AVE P O BOX 8800
CORCORAN CA
93212-9611
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-8800
  • Fax:
Mailing address:
  • Phone: 559-992-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberC50035
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberC50035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: