Healthcare Provider Details

I. General information

NPI: 1154341626
Provider Name (Legal Business Name): HAROUTUN HARRY HOVANESIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N CENTRAL AVE
GLENDALE CA
91203-2001
US

IV. Provider business mailing address

4520 LITTLETON PL
LA CANADA CA
91011-1936
US

V. Phone/Fax

Practice location:
  • Phone: 818-265-7777
  • Fax: 818-241-0087
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA67565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: