Healthcare Provider Details

I. General information

NPI: 1740325570
Provider Name (Legal Business Name): HAROUT R BALIAN M D A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N HILL AVE SUITE 101
PASADENA CA
91106-1570
US

IV. Provider business mailing address

333 N HILL AVE SUITE 101
PASADENA CA
91106-1570
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-9911
  • Fax: 626-449-9921
Mailing address:
  • Phone: 626-449-9911
  • Fax: 626-449-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA ANNE BALIAN
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 626-449-9911