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General NPI Number Information
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NPI Number | 1952672032
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Entity Type | Organization
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Legal Business Name | PRACTICA INC
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 333 N HILL AVE 101
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City | PASADENA
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State | CA
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Zip | 91106-1570
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Country | US
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Telephone | 626-318-2484
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Fax |
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Provider Business Mailing Address
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Address Line | 257 S HUDSON AVE UNIT 304
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City | PASADENA
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State | CA
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Zip | 91101-4324
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Country | US
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Telephone | 626-318-2484
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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. VAHE MELKONYAN
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Credential | MD
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Telephone | 626-318-2484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A97645
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License Number State | CA
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