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General NPI Number Information
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NPI Number | 1407157878
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Entity Type | Organization
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Legal Business Name | SAMUEL A MALAYAN MEDICAL CORP
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Dates
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Enumeration Date | 11/16/2010
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 610 N CENTRAL AVE SUITE 301
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City | GLENDALE
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State | CA
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Zip | 91203-1403
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Country | US
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Telephone | 818-550-0702
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Fax | 818-550-0705
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Provider Business Mailing Address
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Address Line | 610 N CENTRAL AVE SUITE 301
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City | GLENDALE
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State | CA
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Zip | 91203-1403
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Country | US
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Telephone | 818-550-0702
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Fax | 818-550-0705
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SOFYA BAKHTAMYAN
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Credential |
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Telephone | 818-550-0702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G61143
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | G61143
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License Number State | CA
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