Provider Demographics
NPI:1578515847
Name:TAVITIAN, ARMINEH (MD)
Entity Type:Individual
Prefix:DR
First Name:ARMINEH
Middle Name:
Last Name:TAVITIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SOUTH CENTRAL AVE
Mailing Address - Street 2:#200
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204
Mailing Address - Country:US
Mailing Address - Phone:818-637-7613
Mailing Address - Fax:818-637-7616
Practice Address - Street 1:1500 SOUTH CENTRAL AVE
Practice Address - Street 2:#200
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204
Practice Address - Country:US
Practice Address - Phone:818-637-7613
Practice Address - Fax:818-637-7616
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74699207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG15475Medicare UPIN