Healthcare Provider Details

I. General information

NPI: 1356308167
Provider Name (Legal Business Name): GAGIK GREG HAROUTUNIAN MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 S GLENDALE AVE
GLENDALE CA
91205-3349
US

IV. Provider business mailing address

1332 S GLENDALE AVE
GLENDALE CA
91205-3349
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-7147
  • Fax: 818-241-7112
Mailing address:
  • Phone: 818-241-7147
  • Fax: 818-241-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5205709-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC54033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: