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General NPI Number Information
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NPI Number | 1356308167
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Entity Type | Individual
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Provider Name | GAGIK GREG HAROUTUNIAN MD.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 1332 S GLENDALE AVE
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City | GLENDALE
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State | CA
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Zip | 91205-3349
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Country | US
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Telephone | 818-241-7147
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Fax | 818-241-7112
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Provider Business Mailing Address
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Address Line | 1332 S GLENDALE AVE
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City | GLENDALE
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State | CA
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Zip | 91205-3349
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Country | US
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Telephone | 818-241-7147
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Fax | 818-241-7112
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5205709-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | C54033
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License Number State | CA
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