Healthcare Provider Details

I. General information

NPI: 1871598748
Provider Name (Legal Business Name): ARA KELEKIAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W BEVERLY BLVD SUITE 201
MONTEBELLO CA
90640-3665
US

IV. Provider business mailing address

515 W BEVERLY BLVD SUITE 201
MONTEBELLO CA
90640-3665
US

V. Phone/Fax

Practice location:
  • Phone: 323-346-0996
  • Fax: 323-346-0986
Mailing address:
  • Phone: 323-346-0996
  • Fax: 323-346-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4536
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE4536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: