Healthcare Provider Details

I. General information

NPI: 1972799179
Provider Name (Legal Business Name): VACHIK SHAHNAZARIAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S GLENDALE AVE SUITE 304
GLENDALE CA
91205-5612
US

IV. Provider business mailing address

1030 S GLENDALE AVE SUITE 304
GLENDALE CA
91205-5612
US

V. Phone/Fax

Practice location:
  • Phone: 818-291-4041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA84308
License Number StateCA

VIII. Authorized Official

Name: DR. VACHIK SHAHNAZARIAN
Title or Position: PRESIDENT
Credential:
Phone: 818-291-4041