Provider Demographics
NPI:1811948540
Name:MANOUKIAN, ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:MANOUKIAN
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 1:4365 COBBLESTONE LANE
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3217
Mailing Address - Country:US
Mailing Address - Phone:323-919-4071
Mailing Address - Fax:626-696-3680
Practice Address - Street 1:1460 N LAKE AVE
Practice Address - Street 2:# 105
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2300
Practice Address - Country:US
Practice Address - Phone:800-792-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75961207R00000X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherBLUE CROSS
CA$$$$$$$$$OtherBLUE CROSS
CAA75961Medicare PIN