Provider Demographics
NPI:1821020272
Name:ARMEN A. SHAHBAZIAN, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ARMEN A. SHAHBAZIAN, MD, A PROFESSIONAL CORPORATION
Other - Org Name:DBA PACIFIC RADIATION ONCOLOGY MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAHBAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-639-1955
Mailing Address - Street 1:2617 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3226
Mailing Address - Country:US
Mailing Address - Phone:714-639-1955
Mailing Address - Fax:714-639-1958
Practice Address - Street 1:2617 E CHAPMAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3226
Practice Address - Country:US
Practice Address - Phone:714-639-1955
Practice Address - Fax:714-639-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37327174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306849542OtherSOLE PROVIDER NPI
CA00C373270Medicaid
CA00C373270Medicaid
CAA89032Medicare UPIN
CA1306849542OtherSOLE PROVIDER NPI