Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A80337 | CA |
NPI | 1033135488 |
---|---|
Provider Name | Karine Gaboian |
First Address | Glendale, CA 91202-2583 |
Second Address | Glendale, CA 91202-2511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 09/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H72398 | (02) | CA |