Healthcare Provider Details

I. General information

NPI: 1003182437
Provider Name (Legal Business Name): ARTIN NAZARIAN MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S FAIR OAKS AVE 215
PASADENA CA
91105-2613
US

IV. Provider business mailing address

625 S FAIR OAKS AVE 215
PASADENA CA
91105-2613
US

V. Phone/Fax

Practice location:
  • Phone: 626-344-0039
  • Fax: 626-397-2968
Mailing address:
  • Phone: 626-344-0039
  • Fax: 626-397-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA95127
License Number StateCA

VIII. Authorized Official

Name: DR. ARTIN NAZARIAN
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 626-344-0039