Healthcare Provider Details

I. General information

NPI: 1154401701
Provider Name (Legal Business Name): GARO BAYRAK DARIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 E WASHINGTON BLVD SUITE 101
PASADENA CA
91107-1409
US

IV. Provider business mailing address

2595 E WASHINGTON BLVD SUITE 101
PASADENA CA
91107-1409
US

V. Phone/Fax

Practice location:
  • Phone: 626-794-0560
  • Fax: 626-794-6170
Mailing address:
  • Phone: 626-794-0560
  • Fax: 626-794-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC42268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: