Provider Demographics
NPI:1306137476
Name:KHACHATRIAN, AELITA (MD)
Entity type:Individual
Prefix:
First Name:AELITA
Middle Name:
Last Name:KHACHATRIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 77790
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0126
Mailing Address - Country:US
Mailing Address - Phone:951-278-5590
Mailing Address - Fax:951-272-9924
Practice Address - Street 1:558 SAINT CHARLES DRIVE
Practice Address - Street 2:SUITE 110, 111, 124, 204
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3967
Practice Address - Country:US
Practice Address - Phone:951-278-5590
Practice Address - Fax:951-272-9924
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2017-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA127694207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology