Healthcare Provider Details

I. General information

NPI: 1902017650
Provider Name (Legal Business Name): HAIG A. KOSHKARIAN M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 PROSPECT ST STE. 415B
LA JOLLA CA
92037-0068
US

IV. Provider business mailing address

1020 PROSPECT ST STE. 415B
LA JOLLA CA
92037-0068
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-3696
  • Fax: 858-270-6677
Mailing address:
  • Phone: 858-459-3696
  • Fax: 858-270-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License NumberG14651
License Number StateCA

VIII. Authorized Official

Name: HAIG ARAM KOSHKARIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-459-3696