Healthcare Provider Details

I. General information

NPI: 1679164875
Provider Name (Legal Business Name): ARAZ HOUSEPIAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 01/30/2021
Certification Date: 01/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W COLORADO BLVD
PASADENA CA
91105-1925
US

IV. Provider business mailing address

555 E OLIVE AVE APT 112
BURBANK CA
91501-2157
US

V. Phone/Fax

Practice location:
  • Phone: 310-486-0192
  • Fax:
Mailing address:
  • Phone: 818-590-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: