Provider Demographics
NPI:1063442143
Name:AGABABIAN, GOR (MD)
Entity type:Individual
Prefix:DR
First Name:GOR
Middle Name:
Last Name:AGABABIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 S CENTRAL AVE
Mailing Address - Street 2:SUITE #301
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4370
Mailing Address - Country:US
Mailing Address - Phone:818-246-1824
Mailing Address - Fax:818-246-1886
Practice Address - Street 1:800 S CENTRAL AVE
Practice Address - Street 2:SUITE # 301
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4370
Practice Address - Country:US
Practice Address - Phone:818-246-1824
Practice Address - Fax:818-246-1886
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA93668208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice