Provider Demographics
NPI:1407196140
Name:MIRZAIAN, CHRISTINE BOTTRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:BOTTRELL
Last Name:MIRZAIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:LEA
Other - Last Name:BOTTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:MS #76
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2113
Mailing Address - Fax:323-361-8003
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MS #76
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2113
Practice Address - Fax:323-361-8003
Is Sole Proprietor?:No
Enumeration Date:2013-02-16
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115776208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics