Provider Demographics
NPI:1477536738
Name:MESROBIAN, HAROUTIOUN DICCRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROUTIOUN
Middle Name:DICCRAN
Last Name:MESROBIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1008
Mailing Address - Country:US
Mailing Address - Phone:818-243-9600
Mailing Address - Fax:818-243-9605
Practice Address - Street 1:660 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1008
Practice Address - Country:US
Practice Address - Phone:818-243-9600
Practice Address - Fax:818-243-9605
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48097207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A480970Medicaid
CA00A480970Medicaid
CAWA48097CMedicare ID - Type Unspecified