Provider Demographics
NPI:1679959845
Name:MAILYAN, VIOLETTA V (DO)
Entity Type:Individual
Prefix:
First Name:VIOLETTA
Middle Name:V
Last Name:MAILYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209-1150
Mailing Address - Country:US
Mailing Address - Phone:818-484-5434
Mailing Address - Fax:818-484-5350
Practice Address - Street 1:815 E COLORADO ST
Practice Address - Street 2:200
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1200
Practice Address - Country:US
Practice Address - Phone:818-484-5434
Practice Address - Fax:818-484-5350
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine