Healthcare Provider Details

I. General information

NPI: 1487685426
Provider Name (Legal Business Name): ARTHUR GALOUSTIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 PARK SIERRA DR SUITE 208
RIVERSIDE CA
92505-3059
US

IV. Provider business mailing address

3660 PARK SIERRA DR STE 203
RIVERSIDE CA
92505-3071
US

V. Phone/Fax

Practice location:
  • Phone: 951-687-2800
  • Fax: 951-687-7290
Mailing address:
  • Phone: 951-687-3400
  • Fax: 951-687-8923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA95220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: