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NPI Code Detail

MEDICARE: DR. VICTORIA MOURADIAN DMD

MEDICARE: DR. VICTORIA MOURADIAN DMD
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
11223G0001XGeneral Practice Dentistry62435CA

General Provider Information

NPI Number : 1659710432
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VICTORIA MOURADIAN DMD
Provider Business Mailing Address
First Line : 519 SOUTH ST
Second Line : APT 106
City : GLENDALE
State : CA
Zip : 91202-2282
Country : US
Telephone Number : 323-807-2527
Fax Number :
Provider Business Practice Location Address
First Line : 4905 HOLLYWOOD BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-6101
Country : US
Telephone Number : 323-461-9942
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2013
Last Update Date : 06/14/2013

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