Healthcare Provider Details

I. General information

NPI: 1861758005
Provider Name (Legal Business Name): TAMAR NAZERIAN CHORBADJIAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMAR NAZERIAN D.O.

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6161
  • Fax:
Mailing address:
  • Phone: 323-361-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A 13040
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number20A 13040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: