Provider Demographics
NPI:1750770608
Name:IGHIA AINTABLIAN MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:IGHIA AINTABLIAN MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IGHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AINTABLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-500-8822
Mailing Address - Street 1:1510 S CENTRAL AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2510
Mailing Address - Country:US
Mailing Address - Phone:818-500-8822
Mailing Address - Fax:
Practice Address - Street 1:1510 S CENTRAL AVE STE 450
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2510
Practice Address - Country:US
Practice Address - Phone:818-500-8822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA4204712080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty