Healthcare Provider Details

I. General information

NPI: 1649090101
Provider Name (Legal Business Name): LIBERTYMED HEALTH PEDIATRIC URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W GLENOAKS BLVD STE D
GLENDALE CA
91202-2664
US

IV. Provider business mailing address

900 W GLENOAKS BLVD STE D
GLENDALE CA
91202-2664
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-4129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARA SHAFRAZIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 818-384-3804