Provider Demographics
NPI:1619410503
Name:IRADJ NAZARIAN MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:IRADJ NAZARIAN MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IRADJ
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-244-5444
Mailing Address - Street 1:1241 S GLENDALE AVE # 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3385
Mailing Address - Country:US
Mailing Address - Phone:818-244-5444
Mailing Address - Fax:818-243-0193
Practice Address - Street 1:1241 S GLENDALE AVE # 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3385
Practice Address - Country:US
Practice Address - Phone:818-244-5444
Practice Address - Fax:818-243-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty