Active NPI
Medical Clinic and Surgical Specialities of Glendale
- Otolaryngology Physician
- Glendale, CA
National Provider Identifier
1013051085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- G47224
- Legal business name
- MEDICAL CLINIC AND SURGICAL SPECIALITIES OF GLENDALE
- Practice address
- 1510 South Central Ave
Suite #100
Glendale, CA 91204-2582 - Phone
- (818) 240-1820
- Fax
- (818) 240-1021
- NPI assigned
- Feb 16, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mardiros Haig Mihranian, MD
- Title
- President Secretary
- Phone
- (818) 240-1820
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | G47224 | CA | Primary |
Addresses
Primary practice location
1510 South Central Ave
Suite #100
Glendale, CA 91204-2582
Mailing address
1510 South Central Ave
Suite #100
Glendale, CA 91204-2582
Phone (818) 240-1820
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G472240 | Medicaid | CA |
National Provider Directory
National Provider Directory- Tax ID family
- McSsg
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Surgical Physician Assistant
- Glendale, CA
- NPI 1295873719
-
- Surgery Physician
- Glendale, CA
- NPI 1508904731
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1013051085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1510 SOUTH CENTRAL AVE",
"address_2": "SUITE #100",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912042582",
"telephone_number": "818-240-1820",
"fax_number": "818-240-1021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1510 SOUTH CENTRAL AVE",
"address_2": "SUITE #100",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912042582",
"telephone_number": "818-240-1820",
"fax_number": "818-240-1021"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDICAL CLINIC AND SURGICAL SPECIALITIES OF GLENDALE",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-16",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "MIHRANIAN",
"authorized_official_first_name": "MARDIROS",
"authorized_official_middle_name": "HAIG",
"authorized_official_title_or_position": "PRESIDENT SECRETARY",
"authorized_official_telephone_number": "818-240-1820",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Otolaryngology",
"state": "CA",
"license": "G47224",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G472240",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
- Medi-Lab Corporation
- Medi-Move Physicians Inc
- Medical Alliance Group
- Medical and Behavioral Health Associates
- Medical Clinic & Surgical Specialties of Glendale, Inc
- Medical Clinic and Surgical Specialties of Glendale
- Medical Group Imaging Center of Glendale
- Medical Planet Center
- Medical Transport Specialist Corp.
- Medical Transporter LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.