Healthcare Provider Details

I. General information

NPI: 1952533960
Provider Name (Legal Business Name): HAROUTUN ABRAHAMIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 SLAUSON AVE
MAYWOOD CA
90270-2838
US

IV. Provider business mailing address

1441 HIGHLAND AVE
GLENDALE CA
91202-1405
US

V. Phone/Fax

Practice location:
  • Phone: 323-771-9867
  • Fax: 323-771-6094
Mailing address:
  • Phone: 818-317-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA112196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: