Provider Demographics
NPI:1124449384
Name:MARDI H. MIHRANIAN
Entity type:Organization
Organization Name:MARDI H. MIHRANIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARDI
Authorized Official - Middle Name:H
Authorized Official - Last Name:MIHRANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-240-1820
Mailing Address - Street 1:1510 S CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2500
Mailing Address - Country:US
Mailing Address - Phone:818-240-1820
Mailing Address - Fax:818-240-1021
Practice Address - Street 1:1510 S CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2500
Practice Address - Country:US
Practice Address - Phone:818-240-1820
Practice Address - Fax:818-240-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty