Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC-27187 | CA |
NPI | 1013028026 |
---|---|
Provider Name | Mr. Garen Vartanian |
First Address | La Puente, CA 91744-1630 |
Second Address | La Puente, CA 91744-1630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |