Healthcare Provider Details

I. General information

NPI: 1710423405
Provider Name (Legal Business Name): ARAZ M MELKONIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 N GLENDALE AVE STE B
GLENDALE CA
91206-3311
US

IV. Provider business mailing address

2100 POWELL ST STE 400
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 747-212-3441
  • Fax:
Mailing address:
  • Phone: 510-350-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA157310
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA157310
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA157310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: