Provider Demographics
NPI:1558621870
Name:GHAZARIAN, NICK (DO)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:
Last Name:GHAZARIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:NARBEH
Other - Middle Name:
Other - Last Name:GHAZARIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1200 S BRAND BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2641
Mailing Address - Country:US
Mailing Address - Phone:818-579-2929
Mailing Address - Fax:818-579-2929
Practice Address - Street 1:222 W EULALIA ST STE 309
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2851
Practice Address - Country:US
Practice Address - Phone:818-579-2929
Practice Address - Fax:818-579-2929
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13071207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty