Provider Demographics
NPI:1427191055
Name:KHALATIAN, MARIA EUGENIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:EUGENIA
Last Name:KHALATIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N ORANGE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2032
Mailing Address - Country:US
Mailing Address - Phone:626-800-1200
Mailing Address - Fax:
Practice Address - Street 1:11436 GARVEY AVE # A
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3304
Practice Address - Country:US
Practice Address - Phone:626-459-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33207174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33207Medicaid