Healthcare Provider Details

I. General information

NPI: 1851501548
Provider Name (Legal Business Name): SYLVIA KOTIKIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

PO BOX 142
VERDUGO CITY CA
91046-0142
US

V. Phone/Fax

Practice location:
  • Phone: 818-545-3401
  • Fax:
Mailing address:
  • Phone: 818-813-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301085602
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA103145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: