NPIMap

Organization Active NPI

Medical Clinic and Surgical Specialties of Glendale

  • Surgery Physician
  • Glendale, CA
National Provider Identifier
1508904731
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A30059 Issued in CA
Legal business name
MEDICAL CLINIC AND SURGICAL SPECIALTIES OF GLENDALE
Practice address
1510 S Central Ave
#100
Glendale, CA 91204-2582
Phone
(818) 240-1820
Fax
(818) 240-1021
NPI assigned
Feb 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mardiros Haig Mihranian, MDNPI 1093997330
Title
President Secretary
Phone
(818) 240-1820

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A30059 CA Primary

Addresses

Primary practice location

1510 S Central Ave
#100
Glendale, CA 91204-2582

Mailing address

1510 S Central Ave
#100
Glendale, CA 91204-2582
Phone (818) 240-1820

Other identifiers 1

IdentifierTypeStateIssuer
00A300590MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
McSsg3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508904731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S CENTRAL AVE",
            "address_2": "#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 S CENTRAL AVE",
            "address_2": "#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 SPECIALTIES OF GLENDALE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "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": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A30059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A300590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

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.

Verify at the official NPI Registry.