Provider Demographics
NPI:1063660264
Name:HARUTUNIANS, TINA I (DO)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:I
Last Name:HARUTUNIANS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:ISAGHOLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1216
Mailing Address - Country:US
Mailing Address - Phone:626-405-6442
Mailing Address - Fax:
Practice Address - Street 1:450 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1216
Practice Address - Country:US
Practice Address - Phone:626-405-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine