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General NPI Number Information
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NPI Number | 1609233121
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Entity Type | Organization
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Legal Business Name | VATCHE B. BARDAKJIAN, M.D, INC
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 1577 E CHEVY CHASE DR STE 250
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City | GLENDALE
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State | CA
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Zip | 91206-4172
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Country | US
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Telephone | 818-247-4894
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Fax | 818-247-4163
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Provider Business Mailing Address
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Address Line | 1577 E CHEVY CHASE DR STE 250
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City | GLENDALE
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State | CA
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Zip | 91206-4172
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Country | US
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Telephone | 818-247-4894
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Fax | 818-247-4163
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Authorized Official
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Title or Position | CEO
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Name | VATCHE B BARDAKJIAN
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Credential | M.D
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Telephone | 818-247-4894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A45955
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License Number State | CA
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