MEDICARE: DR. MARIA EUGENIA KHALATIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A33207	CA
2	208000000X	Pediatrics Physician	A33207	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427191055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA EUGENIA KHALATIAN M.D.

Provider Business Mailing Address
First Line	:	140 N ORANGE AVE STE 100
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-2032
Country	:	US
Telephone Number	:	626-800-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	11436 GARVEY AVE # A
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-3304
Country	:	US
Telephone Number	:	626-459-5420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	02/03/2022

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