Healthcare Provider Details

I. General information

NPI: 1699397885
Provider Name (Legal Business Name): TEODIK GRIGORIAN DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18531 ROSCOE BLVD STE 215
NORTHRIDGE CA
91324-5975
US

IV. Provider business mailing address

18531 ROSCOE BLVD STE 215
NORTHRIDGE CA
91324-5975
US

V. Phone/Fax

Practice location:
  • Phone: 818-775-5744
  • Fax:
Mailing address:
  • Phone: 818-775-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TEODIK GRIGORIAN
Title or Position: PROVIDER
Credential: DO
Phone: 818-775-5744