Provider Demographics
NPI:1699397885
Name:TEODIK GRIGORIAN DO INC
Entity Type:Organization
Organization Name:TEODIK GRIGORIAN DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TEODIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-775-5744
Mailing Address - Street 1:18531 ROSCOE BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5975
Mailing Address - Country:US
Mailing Address - Phone:818-775-5744
Mailing Address - Fax:
Practice Address - Street 1:18531 ROSCOE BLVD STE 215
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5975
Practice Address - Country:US
Practice Address - Phone:818-775-5744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty