Provider Demographics
NPI:1912091893
Name:ORNEKIAN, NUBAR ANTRANIK (DPM)
Entity Type:Individual
Prefix:DR
First Name:NUBAR
Middle Name:ANTRANIK
Last Name:ORNEKIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N SANTA ANITA AVE
Mailing Address - Street 2:STE J
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3166
Mailing Address - Country:US
Mailing Address - Phone:626-574-7400
Mailing Address - Fax:626-574-7559
Practice Address - Street 1:25 N SANTA ANITA AVE
Practice Address - Street 2:STE J
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3166
Practice Address - Country:US
Practice Address - Phone:626-574-7400
Practice Address - Fax:626-574-7559
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2857213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE000140Medicaid
CAGRE000140Medicaid
T11500Medicare UPIN