Provider Demographics
NPI:1346091238
Name:ACTIVE SPORTS MEDICINE CLINIC
Entity Type:Organization
Organization Name:ACTIVE SPORTS MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ARGIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARITOUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-319-2828
Mailing Address - Street 1:435 ARDEN AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4017
Mailing Address - Country:US
Mailing Address - Phone:818-252-9676
Mailing Address - Fax:
Practice Address - Street 1:435 ARDEN AVE STE 340
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4017
Practice Address - Country:US
Practice Address - Phone:818-252-9676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty