Healthcare Provider Details

I. General information

NPI: 1447307202
Provider Name (Legal Business Name): RAFI HOVANESSIAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W BROADWAY SUITE 235
GLENDALE CA
91204-1033
US

IV. Provider business mailing address

600 W BROADWAY SUITE 235
GLENDALE CA
91204-1033
US

V. Phone/Fax

Practice location:
  • Phone: 818-552-5025
  • Fax: 818-552-5026
Mailing address:
  • Phone: 818-552-5025
  • Fax: 818-552-5026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number30285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: