=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578670964
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARMEN AZATIAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2006
-----------------------------------------------------
Last Update Date | 06/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12450 VAN NUYS BLVD STE 200
-----------------------------------------------------
City | PACOIMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91331-1393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-896-1161
-----------------------------------------------------
Fax | 818-896-5069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12450 VAN NUYS BLVD STE 200
-----------------------------------------------------
City | PACOIMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91331-1393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-896-1161
-----------------------------------------------------
Fax | 818-896-5069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A89967
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------