Healthcare Provider Details

I. General information

NPI: 1023656980
Provider Name (Legal Business Name): MANIA GHARIBIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 VERDUGO BLVD
MONTROSE CA
91020-1626
US

IV. Provider business mailing address

985 VERDUGO CIRCLE DR
GLENDALE CA
91206-1535
US

V. Phone/Fax

Practice location:
  • Phone: 818-248-8018
  • Fax:
Mailing address:
  • Phone: 818-565-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number81013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: