Provider Demographics
NPI:1699786400
Name:TERTZAKIAN, GARO M
Entity type:Individual
Prefix:DR
First Name:GARO
Middle Name:M
Last Name:TERTZAKIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N TUSTIN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3600
Mailing Address - Country:US
Mailing Address - Phone:714-480-0208
Mailing Address - Fax:
Practice Address - Street 1:801 N TUSTIN AVE STE 202
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3600
Practice Address - Country:US
Practice Address - Phone:714-480-0208
Practice Address - Fax:714-480-0210
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37346208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C37346AMedicare ID - Type Unspecified
A36581Medicare UPIN