Provider Demographics
NPI:1992816532
Name:KOCHARIAN, NAIRA (MD)
Entity type:Individual
Prefix:
First Name:NAIRA
Middle Name:
Last Name:KOCHARIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 927157
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92192-7157
Mailing Address - Country:US
Mailing Address - Phone:858-281-1588
Mailing Address - Fax:858-281-1589
Practice Address - Street 1:8650 GENESEE AVE # 214
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92192-6001
Practice Address - Country:US
Practice Address - Phone:858-281-1588
Practice Address - Fax:858-281-1589
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA938812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93881OtherLICENSE
CABK9678852OtherDEA