Healthcare Provider Details

I. General information

NPI: 1518587815
Provider Name (Legal Business Name): AIRE MEDICAL OF GLENDALE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 VERDUGO BLVD STE 116
GLENDALE CA
91208-1455
US

IV. Provider business mailing address

1808 VERDUGO BLVD STE 116
GLENDALE CA
91208-1455
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: 818-427-4619