Healthcare Provider Details

I. General information

NPI: 1750598025
Provider Name (Legal Business Name): GEORGIOS A. HARTAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N CENTRAL AVE STE 250
GLENDALE CA
91203-2061
US

IV. Provider business mailing address

411 N CENTRAL AVE STE 250
GLENDALE CA
91203-2061
US

V. Phone/Fax

Practice location:
  • Phone: 818-839-7101
  • Fax: 818-839-7199
Mailing address:
  • Phone: 818-839-7101
  • Fax: 818-839-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number145986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: