Provider Demographics
NPI:1225467590
Name:ALLERGY AND ASTHMA TREATMENT CENTER P C
Entity Type:Organization
Organization Name:ALLERGY AND ASTHMA TREATMENT CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMIRJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-558-5828
Mailing Address - Street 1:1131 N PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2358
Mailing Address - Country:US
Mailing Address - Phone:818-558-5828
Mailing Address - Fax:888-717-1542
Practice Address - Street 1:1131 N PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2358
Practice Address - Country:US
Practice Address - Phone:818-558-5828
Practice Address - Fax:888-717-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111311207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB209313Medicare PIN