Healthcare Provider Details

I. General information

NPI: 1093129785
Provider Name (Legal Business Name): ADRINE YADEGARIAN, M.D., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N CENTRAL AVE #130
GLENDALE CA
91203-2081
US

IV. Provider business mailing address

411 N CENTRAL AVE #130
GLENDALE CA
91203-2081
US

V. Phone/Fax

Practice location:
  • Phone: 818-550-1965
  • Fax: 818-550-1966
Mailing address:
  • Phone: 818-550-1965
  • Fax: 818-550-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA117160
License Number StateCA

VIII. Authorized Official

Name: DR. ADRINE YADEGARIAN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 818-550-1965