=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396991006
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GASSIA TITIZIAN D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2008
-----------------------------------------------------
Last Update Date | 08/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1620 VICTORY BLVD
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91201-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-752-0366
-----------------------------------------------------
Fax | 818-247-2722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1620 VICTORY BLVD
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91201-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-752-0366
-----------------------------------------------------
Fax | 818-247-2722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 30877
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------