Healthcare Provider Details

I. General information

NPI: 1548358369
Provider Name (Legal Business Name): IGHIA AINTABLIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 SOUTH CENTRAL AVE #450
GLENDALE CA
91204
US

IV. Provider business mailing address

1510 SOUTH CENTRAL AVE #450
GLENDALE CA
91204
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-8822
  • Fax: 818-500-1003
Mailing address:
  • Phone: 818-500-8822
  • Fax: 818-500-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA42047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: