Healthcare Provider Details

I. General information

NPI: 1205768728
Provider Name (Legal Business Name): GAYANE GALUSTANIAN MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 CANADA BLVD STE 2
GLENDALE CA
91208-2089
US

IV. Provider business mailing address

2505 CANADA BLVD STE 2
GLENDALE CA
91208-2089
US

V. Phone/Fax

Practice location:
  • Phone: 747-231-5929
  • Fax:
Mailing address:
  • Phone: 747-231-5929
  • Fax: 747-238-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GAYANE GALUSTANIAN
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 747-231-5929