Healthcare Provider Details

I. General information

NPI: 1215992367
Provider Name (Legal Business Name): TAVITIAN GASTROENTEROLOGY MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SOUTH CHEVY CHASE DRIVE #102
GLENDALE CA
91205
US

IV. Provider business mailing address

801 SOUTH CHEVY CHASE DRIVE #102
GLENDALE CA
91205
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-8916
  • Fax: 818-241-7708
Mailing address:
  • Phone: 818-242-8916
  • Fax: 818-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ARA TAVITIAN
Title or Position: OWNER
Credential: M.D.
Phone: 818-242-8916