Provider Demographics
NPI:1972955045
Name:MARKARIAN, POLET
Entity Type:Individual
Prefix:
First Name:POLET
Middle Name:
Last Name:MARKARIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 IRVING AVE
Mailing Address - Street 2:APT 9
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1585
Mailing Address - Country:US
Mailing Address - Phone:818-876-2447
Mailing Address - Fax:
Practice Address - Street 1:1150 IRVING AVE
Practice Address - Street 2:APT 9
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1585
Practice Address - Country:US
Practice Address - Phone:818-876-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist