Provider Demographics
NPI:1205970696
Name:ZADORIAN, ROMIK (MD)
Entity type:Individual
Prefix:
First Name:ROMIK
Middle Name:
Last Name:ZADORIAN
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 1:16661 VENTURA BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1902
Mailing Address - Country:US
Mailing Address - Phone:818-600-4989
Mailing Address - Fax:818-600-4840
Practice Address - Street 1:16661 VENTURA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1902
Practice Address - Country:US
Practice Address - Phone:818-600-4989
Practice Address - Fax:818-600-4840
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102111207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413328500Medicaid
MD413046400Medicaid
CAFX236ZMedicare PIN
MDR435Medicare PIN
MD489PR435Medicare PIN