Glendale Primary Care Center Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A13819 Issued in CA

Legal business name

GLENDALE PRIMARY CARE CENTER INC

Practice address

1204 S Central Ave
Glendale, CA 91204-2504

Phone

(818) 551-0001

Fax

(818) 551-0074

NPI assigned

Aug 12, 2016

Last updated

Jan 23, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Meri Antossyan, DO

Title

Owner/Provider

Phone

(818) 551-0001

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485129600000",
    "number": "1336693894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 S CENTRAL AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042504",
            "telephone_number": "818-551-0001",
            "fax_number": "818-551-0074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 S CENTRAL AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042504",
            "telephone_number": "818-551-0001",
            "fax_number": "818-551-0074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE PRIMARY CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-12",
        "last_updated": "2017-01-23",
        "status": "A",
        "authorized_official_last_name": "ANTOSSYAN",
        "authorized_official_first_name": "MERI",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "818-551-0001",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A13819",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Glendale Retina Associates Medical Group Inc.
• Glendale Sleep Diagnostic Center
• Glendale Surgical Associates (Pacific Coast OMS)

• Family Medicine Physician in Glendale, CA
• Providers in Glendale, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.