Healthcare Provider Details

I. General information

NPI: 1588541783
Provider Name (Legal Business Name): GARUKYANDPM, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 W COLORADO ST
GLENDALE CA
91204-1537
US

IV. Provider business mailing address

423 W COLORADO ST
GLENDALE CA
91204-1537
US

V. Phone/Fax

Practice location:
  • Phone: 818-697-8767
  • Fax: 818-697-8776
Mailing address:
  • Phone: 818-697-8767
  • Fax: 818-697-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NAREK GARUKYAN
Title or Position: CEO
Credential: DPM
Phone: 818-697-8767