Healthcare Provider Details

I. General information

NPI: 1801161047
Provider Name (Legal Business Name): ARA A. POLADIAN, M.D.,FACOG,PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 04/11/2012
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 TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberA40162
License Number StateCA

VIII. Authorized Official

Name: DR. ARA A POLADIAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-763-2992