Provider Demographics
NPI:1619176757
Name:ABAJIAN, MICHELLE D (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:ABAJIAN
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 1:1346 FOOTHILL BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2143
Mailing Address - Country:US
Mailing Address - Phone:818-790-5583
Mailing Address - Fax:818-790-9517
Practice Address - Street 1:1346 FOOTHILL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2143
Practice Address - Country:US
Practice Address - Phone:818-790-5583
Practice Address - Fax:818-790-9517
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ54049YOtherBS/TRIWEST
CA1316113145Medicaid
CAA92905OtherCA MED LIC
CA1619176757Medicaid
CA1316113145Medicaid
CAAS789ZMedicare PIN