Provider Demographics
NPI:1578770426
Name:ANDRE ABOOLIAN, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ANDRE ABOOLIAN, M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOOLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-888-8862
Mailing Address - Street 1:1146 NORTH CENTRAL AVE
Mailing Address - Street 2:#101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202
Mailing Address - Country:US
Mailing Address - Phone:310-888-8862
Mailing Address - Fax:310-888-8711
Practice Address - Street 1:120 SOUTH SPALDING DRIVE
Practice Address - Street 2:#200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212
Practice Address - Country:US
Practice Address - Phone:310-888-8862
Practice Address - Fax:310-888-8711
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDRE ABOOLIAN, M.D., A PROFESSIONAL MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-17
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA813472086S0122X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty