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General NPI Number Information
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NPI Number | 1366600355
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Entity Type | Organization
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Legal Business Name | NAZARETH E DARAKJIAN
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 07/23/2011
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Provider Practice Location Address
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Address Line | 2595 E WASHINGTON BLVD SUITE 102
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City | PASADENA
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State | CA
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Zip | 91107-1409
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Country | US
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Telephone | 626-794-2356
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Fax |
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Provider Business Mailing Address
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Address Line | 2595 E WASHINGTON BLVD SUITE 102
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City | PASADENA
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State | CA
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Zip | 91107-1409
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Country | US
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Telephone | 626-794-2356
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NAZARETH E DARAKJIAN
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Credential | M.D.
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Telephone | 626-794-2356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | G 44736
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License Number State | CA
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