Provider Demographics
NPI:1477795029
Name:TALENE CHURUKIAN, D.O., M.P.H., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TALENE CHURUKIAN, D.O., M.P.H., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURUKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH
Authorized Official - Phone:818-602-7654
Mailing Address - Street 1:630 S RAYMOND AVE
Mailing Address - Street 2:310
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3278
Mailing Address - Country:US
Mailing Address - Phone:626-344-0430
Mailing Address - Fax:626-956-0565
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:310
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-344-0430
Practice Address - Fax:626-956-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-28
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9346207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty