Healthcare Provider Details

I. General information

NPI: 1174899587
Provider Name (Legal Business Name): RAZMIG KRUMIAN D.O. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32144 AGOURA RD SUITE 218
WESTLAKE VILLAGE CA
91361-4031
US

IV. Provider business mailing address

32144 AGOURA RD SUITE 218
WESTLAKE VILLAGE CA
91361-4031
US

V. Phone/Fax

Practice location:
  • Phone: 818-889-9230
  • Fax: 818-889-9235
Mailing address:
  • Phone: 818-889-9230
  • Fax: 818-889-9235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7776
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A8716
License Number StateCA

VIII. Authorized Official

Name: RAZMIG KRUMIAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 818-889-9230