MEDICARE: VICTOR A. GABRIELIAN 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	207RC0000X	Cardiovascular Disease Physician	A101256	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207UN0901X	Nuclear Cardiology Physician	A101256	CA

General Provider Information

NPI Number	:	1811189822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR A. GABRIELIAN M.D.

Provider Business Mailing Address
First Line	:	3452 E FOOTHILL BLVD
Second Line	:	SUITE 130
City	:	PASADENA
State	:	CA
Zip	:	91107-3142
Country	:	US
Telephone Number	:	626-793-2885
Fax Number	:	626-796-9648

Provider Business Practice Location Address
First Line	:	289 W HUNTINGTON DR STE 401
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-3493
Country	:	US
Telephone Number	:	626-915-4700
Fax Number	:	626-214-7814

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

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	02/28/2020

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