Provider Demographics
NPI:1235336397
Name:GARO M. TERTZAKIAN, M.D., INC.
Entity Type:Organization
Organization Name:GARO M. TERTZAKIAN, M.D., INC.
Other - Org Name:ASSOCIATED UROLOGISTS OF ORANGE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARO
Authorized Official - Middle Name:M
Authorized Official - Last Name:TERTZAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-639-1915
Mailing Address - Street 1:1801 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2607
Mailing Address - Country:US
Mailing Address - Phone:714-639-1915
Mailing Address - Fax:714-824-6896
Practice Address - Street 1:1801 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2607
Practice Address - Country:US
Practice Address - Phone:714-639-1915
Practice Address - Fax:714-824-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37346174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36581Medicare UPIN
CAC37346AMedicare ID - Type UnspecifiedSPECISLIST