Provider Demographics
NPI:1700109519
Name:KREKOR A TOMASSIAN MD A PROF CORP
Entity Type:Organization
Organization Name:KREKOR A TOMASSIAN MD A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KREKOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOMASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-963-0900
Mailing Address - Street 1:415 W ROUT 66
Mailing Address - Street 2:201
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740
Mailing Address - Country:US
Mailing Address - Phone:626-963-0900
Mailing Address - Fax:626-963-9663
Practice Address - Street 1:415 W ROUT 66
Practice Address - Street 2:201
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740
Practice Address - Country:US
Practice Address - Phone:626-963-0900
Practice Address - Fax:626-963-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty