MEDICARE: DR. ARTHUR MANOUKIAN 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	207R00000X	Internal Medicine Physician	A75961	CA
2	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	A75961	CA

General Provider Information

NPI Number	:	1811948540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARTHUR MANOUKIAN M.D.

Provider Business Mailing Address
First Line	:	4365 COBBLESTONE LANE
Second Line	:
City	:	LA CANADA FLINTRIDGE
State	:	CA
Zip	:	91011-3217
Country	:	US
Telephone Number	:	323-919-4071
Fax Number	:	626-696-3680

Provider Business Practice Location Address
First Line	:	1460 N LAKE AVE
Second Line	:	# 105
City	:	PASADENA
State	:	CA
Zip	:	91104-2300
Country	:	US
Telephone Number	:	800-792-2345
Fax Number	:

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	01/29/2013

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