Provider Demographics
NPI:1821213679
Name:VARTANIAN, ARA JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ARA
Middle Name:JOHN
Last Name:VARTANIAN
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 1:520 E BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4926
Mailing Address - Country:US
Mailing Address - Phone:818-662-0600
Mailing Address - Fax:818-662-0145
Practice Address - Street 1:520 E BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4926
Practice Address - Country:US
Practice Address - Phone:818-662-0600
Practice Address - Fax:818-662-0145
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI16006Medicare UPIN