Provider Demographics
NPI:1548535289
Name:GREG HAROUTUNIAN,MD INC
Entity type:Organization
Organization Name:GREG HAROUTUNIAN,MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAGIK
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:HAROUTUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-282-9910
Mailing Address - Street 1:311 S REXFORD DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4607
Mailing Address - Country:US
Mailing Address - Phone:310-282-9910
Mailing Address - Fax:
Practice Address - Street 1:1332 S GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3349
Practice Address - Country:US
Practice Address - Phone:310-282-9910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54033261QP2300X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care