Provider Demographics
NPI:1881641488
Name:YACOBIAN, SONIA H (MD)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:H
Last Name:YACOBIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E COLORADO ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1298
Mailing Address - Country:US
Mailing Address - Phone:818-244-5444
Mailing Address - Fax:
Practice Address - Street 1:815 E COLORADO ST STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1298
Practice Address - Country:US
Practice Address - Phone:818-244-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52602174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF72186Medicare UPIN
CAA52602AMedicare ID - Type Unspecified