Provider Demographics
NPI:1225433006
Name:MADATOVIAN, HARUT (DO)
Entity Type:Individual
Prefix:
First Name:HARUT
Middle Name:
Last Name:MADATOVIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8239 HATILLO AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1911
Mailing Address - Country:US
Mailing Address - Phone:818-203-1797
Mailing Address - Fax:
Practice Address - Street 1:2595 E WASHINGTON BLVD STE 106
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1409
Practice Address - Country:US
Practice Address - Phone:818-203-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15143207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine