Provider Demographics
NPI:1598837692
Name:SETHIAN, NUBAR ARAM (MD)
Entity Type:Individual
Prefix:
First Name:NUBAR
Middle Name:ARAM
Last Name:SETHIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NUBAR
Other - Middle Name:A
Other - Last Name:SETHIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1028 N LAKE AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104
Mailing Address - Country:US
Mailing Address - Phone:626-797-3378
Mailing Address - Fax:626-797-4812
Practice Address - Street 1:1028 N LAKE AVE
Practice Address - Street 2:STE 103
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104
Practice Address - Country:US
Practice Address - Phone:626-797-3378
Practice Address - Fax:626-797-4812
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44867207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A44867Medicaid
CA00A44867Medicaid
A44867Medicare ID - Type Unspecified