Provider Demographics
NPI:1083198808
Name:ARA SHAFRAZIAN MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ARA SHAFRAZIAN MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFRAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-241-4129
Mailing Address - Street 1:435 ARDEN AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:818-241-0472
Practice Address - Street 1:435 ARDEN AVE STE 450
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4024
Practice Address - Country:US
Practice Address - Phone:818-241-4129
Practice Address - Fax:818-241-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care