Healthcare Provider Details

I. General information

NPI: 1528245586
Provider Name (Legal Business Name): ARMINEH TAVITIAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CENTRAL AVE 200
GLENDALE CA
91204-2530
US

IV. Provider business mailing address

1500 S CENTRAL AVE 200
GLENDALE CA
91204-2530
US

V. Phone/Fax

Practice location:
  • Phone: 818-637-7613
  • Fax: 818-637-7616
Mailing address:
  • Phone: 818-637-7613
  • Fax: 818-637-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG74699
License Number StateCA

VIII. Authorized Official

Name: FLORA POLADYAN
Title or Position: COO
Credential:
Phone: 818-265-2210