Healthcare Provider Details

I. General information

NPI: 1427965003
Provider Name (Legal Business Name): HARUT TARAKCHIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6677 SANTA MONICA BLVD
LOS ANGELES CA
90038-1374
US

IV. Provider business mailing address

11523 MELETO LN
PORTER RANCH CA
91326-4088
US

V. Phone/Fax

Practice location:
  • Phone: 323-943-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT310601
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: