=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205478252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARAZ MELKONIAN MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2019
-----------------------------------------------------
Last Update Date | 04/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1509 WILSON TER
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91206-4007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-731-8972
-----------------------------------------------------
Fax | 336-916-1821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1140 E DORAN ST APT C
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91206-3431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-731-8972
-----------------------------------------------------
Fax | 336-916-1821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/A.O.
-----------------------------------------------------
Name | DR. ARAZ MELKONIAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-731-8972
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------