Provider Demographics
NPI:1558447607
Name:TEKKELIAN, TSOVINAR (MD)
Entity Type:Individual
Prefix:DR
First Name:TSOVINAR
Middle Name:
Last Name:TEKKELIAN
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 1:1251 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3204
Mailing Address - Country:US
Mailing Address - Phone:818-500-9393
Mailing Address - Fax:818-500-1046
Practice Address - Street 1:1251 S GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3204
Practice Address - Country:US
Practice Address - Phone:818-500-9393
Practice Address - Fax:818-500-1046
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52251207RI0200X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558447607Medicaid
CAG17483Medicare UPIN