Provider Demographics
NPI:1841557576
Name:GARABED NISHANIAN, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GARABED NISHANIAN, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARABED
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-429-8840
Mailing Address - Street 1:4740 LOS FELIZ BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1918
Mailing Address - Country:US
Mailing Address - Phone:949-429-8840
Mailing Address - Fax:949-347-9647
Practice Address - Street 1:26800 CROWN VALLEY PKWY STE 420
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8023
Practice Address - Country:US
Practice Address - Phone:949-429-8840
Practice Address - Fax:949-347-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA525372086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty