Healthcare Provider Details

I. General information

NPI: 1750733176
Provider Name (Legal Business Name): TIGRAN GARABEDYAN DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13711 FOOTHILL BLVD SUITE B
SYLMAR CA
91342-3138
US

IV. Provider business mailing address

13711 FOOTHILL BLVD SUITE B
SYLMAR CA
91342-3136
US

V. Phone/Fax

Practice location:
  • Phone: 818-408-8008
  • Fax: 818-408-8011
Mailing address:
  • Phone: 818-408-8008
  • Fax: 818-408-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TIGRAN GARABEDYAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 818-408-8008