Healthcare Provider Details

I. General information

NPI: 1972083178
Provider Name (Legal Business Name): NAREK GARUKYAN DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 TAMPA AVE STE 106
RESEDA CA
91335-1713
US

IV. Provider business mailing address

9518 VIA SALERNO
BURBANK CA
91504-1229
US

V. Phone/Fax

Practice location:
  • Phone: 818-697-8767
  • Fax: 818-697-8776
Mailing address:
  • Phone: 818-683-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5012
License Number StateCA

VIII. Authorized Official

Name: NAREK GARUKYAN
Title or Position: PODIATRIST
Credential: DPM
Phone: 818-683-4344