1689682544 NPI number — GLEN JOHN APRAMIAN MD INC

Table of content: (NPI 1689682544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689682544 NPI number — GLEN JOHN APRAMIAN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLEN JOHN APRAMIAN MD INC
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:
ST GEORGES MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689682544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1750 EAST COLORADO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91106-2225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-440-0097
Provider Business Mailing Address Fax Number:
626-440-0102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 EAST COLORADO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91106-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-440-0097
Provider Business Practice Location Address Fax Number:
626-440-0102
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
APRAMIAN
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-440-0097

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  GS0348 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2083X0100X , with the licence number: GS0348 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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