Healthcare Provider Details

I. General information

NPI: 1578515847
Provider Name (Legal Business Name): ARMINEH TAVITIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SOUTH CENTRAL AVE #200
GLENDALE CA
91204
US

IV. Provider business mailing address

1500 SOUTH CENTRAL AVE #200
GLENDALE CA
91204
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:
Title or Position:
Credential:
Phone: