Healthcare Provider Details

I. General information

NPI: 1457450439
Provider Name (Legal Business Name): ARA A POLADIAN M.D., F.A.C.O.G.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10876 RIVERSIDE DR
NORTH HOLLYWOOD CA
91602-2236
US

IV. Provider business mailing address

10876 RIVERSIDE DR
NORTH HOLLYWOOD CA
91602-2236
US

V. Phone/Fax

Practice location:
  • Phone: 818-763-2992
  • Fax: 818-763-6054
Mailing address:
  • Phone: 818-763-2992
  • Fax: 818-763-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA40162
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA40162
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA40162
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA40162
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA40162
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA40162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: