Provider Demographics
NPI:1255669362
Name:ALEN MIRZAIAN, MD INC
Entity Type:Organization
Organization Name:ALEN MIRZAIAN, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-790-1145
Mailing Address - Street 1:2155 VERDUGO BLVD # 24
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1628
Mailing Address - Country:US
Mailing Address - Phone:818-790-1145
Mailing Address - Fax:818-790-6387
Practice Address - Street 1:1818 VERDUGO BLVD STE 401
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1421
Practice Address - Country:US
Practice Address - Phone:818-790-1145
Practice Address - Fax:818-790-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty