Healthcare Provider Details

I. General information

NPI: 1497924864
Provider Name (Legal Business Name): MAXIM MORADIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MAX MORADIAN M.D.

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 04/13/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE STE 301
GLENDALE CA
91204-4388
US

IV. Provider business mailing address

2627 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

V. Phone/Fax

Practice location:
  • Phone: 818-338-6860
  • Fax: 888-425-9079
Mailing address:
  • Phone: 626-797-2002
  • Fax: 626-798-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD442485
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD202793
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA118692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: