Healthcare Provider Details

I. General information

NPI: 1558638833
Provider Name (Legal Business Name): HRACHYA PARUYRYAN, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 S GLENDALE AVE
GLENDALE CA
91205-3349
US

IV. Provider business mailing address

1332 S GLENDALE AVE
GLENDALE CA
91205-3349
US

V. Phone/Fax

Practice location:
  • Phone: 818-243-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA97760
License Number StateCA

VIII. Authorized Official

Name: HRACHYA PARUYRYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-243-4500