=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467648329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST COAST DOCTORS MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2007
-----------------------------------------------------
Last Update Date | 06/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 814 E BROADWAY # 1
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-1218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-265-5040
-----------------------------------------------------
Fax | 818-242-1411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 814 E BROADWAY # 1
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-1218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-265-5040
-----------------------------------------------------
Fax | 818-242-1411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NARINE ARUTYOUNIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-265-5040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A72468
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------