Provider Demographics
NPI:1063480192
Name:HARONIAN, EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:HARONIAN
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 1:5651 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2916
Mailing Address - Country:US
Mailing Address - Phone:818-788-2400
Mailing Address - Fax:818-788-2453
Practice Address - Street 1:5651 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-2916
Practice Address - Country:US
Practice Address - Phone:818-788-2400
Practice Address - Fax:818-788-2453
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA71385Medicare ID - Type Unspecified