Healthcare Provider Details

I. General information

NPI: 1629458765
Provider Name (Legal Business Name): AIDA K RECHDOUNI, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 FOOTHILL BLVD STE 102
LA CRESCENTA CA
91214-3574
US

IV. Provider business mailing address

2750 PINERIDGE PL
LA CRESCENTA CA
91214-1458
US

V. Phone/Fax

Practice location:
  • Phone: 888-610-8909
  • Fax: 888-610-8908
Mailing address:
  • Phone: 818-468-2929
  • Fax: 888-610-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA72786
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF00342461
License Number StateCA

VIII. Authorized Official

Name: DR. AIDA KAROUN RECHDOUNI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-468-2929