Healthcare Provider Details

I. General information

NPI: 1306860465
Provider Name (Legal Business Name): RAFFI R MINASIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CENTRAL AVE SUITE300
GLENDALE CA
91204-2530
US

IV. Provider business mailing address

1500 S CENTRAL AVE SUITE300
GLENDALE CA
91204-2530
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-0475
  • Fax: 818-662-0260
Mailing address:
  • Phone: 818-242-0475
  • Fax: 818-662-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG52887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: