Healthcare Provider Details

I. General information

NPI: 1912362443
Provider Name (Legal Business Name): PARONIAN MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11631 VICTORY BLVD. SUITE 105
NORTH HOLLYWOOD CA
91606
US

IV. Provider business mailing address

11631 VICTORY BLVD SUITE 105
NORTH HOLLYWOOD CA
91606-3572
US

V. Phone/Fax

Practice location:
  • Phone: 818-732-7770
  • Fax: 818-762-2077
Mailing address:
  • Phone: 818-732-7770
  • Fax: 818-762-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA107875
License Number StateCO

VIII. Authorized Official

Name: MR. GREGOR PARONIAN
Title or Position: OWNER
Credential: M.D.
Phone: 818-732-7770