Provider Demographics
NPI:1033505268
Name:MALIKIAN, RAPHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:T
Last Name:MALIKIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7083 HOLLYWOOD BLVD STE 4099
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8901
Mailing Address - Country:US
Mailing Address - Phone:818-319-2561
Mailing Address - Fax:833-904-2779
Practice Address - Street 1:7083 HOLLYWOOD BLVD STE 4099
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-8901
Practice Address - Country:US
Practice Address - Phone:818-319-2561
Practice Address - Fax:833-904-2779
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine