Provider Demographics
NPI:1306016357
Name:NAZARETH E DARAKJIAN MD
Entity Type:Organization
Organization Name:NAZARETH E DARAKJIAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZARETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:DARAKJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-665-5572
Mailing Address - Street 1:5101 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2478
Mailing Address - Country:US
Mailing Address - Phone:323-665-5572
Mailing Address - Fax:323-665-5579
Practice Address - Street 1:5101 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 4A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2478
Practice Address - Country:US
Practice Address - Phone:323-665-5572
Practice Address - Fax:323-665-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44736332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G447361Medicaid
CAA92521Medicare UPIN
CAG44736AMedicare PIN