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General NPI Number Information
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NPI Number | 1205077039
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Entity Type | Organization
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Legal Business Name | OLIVE HEALTH MEDICAL GROUP INC
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 500 E OLIVE AVE SUITE 315
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City | BURBANK
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State | CA
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Zip | 91501-3316
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Country | US
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Telephone | 818-972-1000
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Fax | 818-972-9007
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Provider Business Mailing Address
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Address Line | 500 E OLIVE AVE SUITE 315
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City | BURBANK
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State | CA
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Zip | 91501-3316
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Country | US
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Telephone | 818-972-1000
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Fax | 818-972-9007
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KARINE KIRAKOSYAN
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Credential |
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Telephone | 818-972-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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