Healthcare Provider Details

I. General information

NPI: 1811948540
Provider Name (Legal Business Name): ARTHUR MANOUKIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N LAKE AVE # 105
PASADENA CA
91104-2300
US

IV. Provider business mailing address

4365 COBBLESTONE LANE
LA CANADA FLINTRIDGE CA
91011-3217
US

V. Phone/Fax

Practice location:
  • Phone: 800-792-2345
  • Fax:
Mailing address:
  • Phone: 323-919-4071
  • Fax: 626-696-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA75961
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberA75961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: