Healthcare Provider Details

I. General information

NPI: 1013337732
Provider Name (Legal Business Name): TATEVIK MARKARYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E COLORADO ST
GLENDALE CA
91205-1514
US

IV. Provider business mailing address

4760 SEPULVEDA BLVD
CULVER CITY CA
90230-4820
US

V. Phone/Fax

Practice location:
  • Phone: 310-390-6612
  • Fax:
Mailing address:
  • Phone: 310-390-6612
  • Fax: 310-398-5690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number847548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: