1841557576 NPI number — GARABED NISHANIAN, M.D., A MEDICAL CORPORATION

Table of content: (NPI 1841557576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841557576 NPI number — GARABED NISHANIAN, M.D., A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARABED NISHANIAN, M.D., A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1841557576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4740 LOS FELIZ BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90027-1918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-429-8840
Provider Business Mailing Address Fax Number:
949-347-9647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26800 CROWN VALLEY PKWY STE 420
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-8023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-429-8840
Provider Business Practice Location Address Fax Number:
949-347-9647
Provider Enumeration Date:
04/19/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NISHANIAN
Authorized Official First Name:
GARABED
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
949-429-8840

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  A52537 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)