Provider Demographics
NPI:1972083178
Name:NAREK GARUKYAN DPM
Entity type:Organization
Organization Name:NAREK GARUKYAN DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:NAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:GARUKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-683-4344
Mailing Address - Street 1:9518 VIA SALERNO
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-1229
Mailing Address - Country:US
Mailing Address - Phone:818-683-4344
Mailing Address - Fax:
Practice Address - Street 1:7640 TAMPA AVE STE 106
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1713
Practice Address - Country:US
Practice Address - Phone:818-697-8767
Practice Address - Fax:818-697-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5012213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty