Provider Demographics
NPI:1811352040
Name:VARTANIAN, REVIK (DO)
Entity type:Individual
Prefix:
First Name:REVIK
Middle Name:
Last Name:VARTANIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N 5TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3712
Mailing Address - Country:US
Mailing Address - Phone:626-460-1096
Mailing Address - Fax:888-425-9079
Practice Address - Street 1:51 N 5TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3712
Practice Address - Country:US
Practice Address - Phone:626-460-1096
Practice Address - Fax:888-425-9079
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA150812081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty