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General NPI Number Information
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NPI Number | 1548535289
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Entity Type | Organization
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Legal Business Name | GREG HAROUTUNIAN,MD INC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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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 | 310-282-9910
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Fax |
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Provider Business Mailing Address
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Address Line | 311 S REXFORD DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-4607
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Country | US
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Telephone | 310-282-9910
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GAGIK GREG HAROUTUNIAN
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Credential | MD
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Telephone | 310-282-9910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | C54033
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C54033
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License Number State | CA
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