Provider Demographics
NPI:1619279213
Name:GAZARIAN, AIK (MD)
Entity Type:Individual
Prefix:
First Name:AIK
Middle Name:
Last Name:GAZARIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26502 CACTUS AVE
Mailing Address - Street 2:SUITE B2017
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555
Mailing Address - Country:US
Mailing Address - Phone:951-486-5611
Mailing Address - Fax:951-486-5620
Practice Address - Street 1:26502 CACTUS AVE
Practice Address - Street 2:B2017
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555
Practice Address - Country:US
Practice Address - Phone:951-486-5611
Practice Address - Fax:951-486-5620
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA114703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine