Organization Active NPI

M Houssig Donabedian PC

  • Internal Medicine Physician
  • Glendale, CA
National Provider Identifier
1780984294
Registry record updated Oct 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C54188 Issued in CA
Legal business name
M HOUSSIG DONABEDIAN PC
Practice address
1130 Campbell St
112
Glendale, CA 91207-1609
Phone
(877) 812-0376
NPI assigned
Oct 31, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2010

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

Authorized official

Name
Maral Donabedian
Title
Ceo
Phone
(877) 812-0376

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X C54188 CA Primary

Addresses

Primary practice location

1130 Campbell St
112
Glendale, CA 91207-1609

Mailing address

PO Box 1041
Glendale, CA 91209-1041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110131000056 CA Part B Supplier - Clinic/Group Practice 9436338993 Receives reassigned benefits from 1 practitioner
Practice locations: West Hollywood, CA

National Provider Directory

National Provider Directory

Locations

312 S Beverly Dr
Unit 3021
Beverly Hills, CA 90212

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1288483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288483200000",
    "number": "1780984294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1041",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912091041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 CAMPBELL ST",
            "address_2": "112",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912071609",
            "telephone_number": "877-812-0376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M HOUSSIG DONABEDIAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-31",
        "last_updated": "2010-10-31",
        "status": "A",
        "authorized_official_last_name": "DONABEDIAN",
        "authorized_official_first_name": "MARAL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "877-812-0376"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C54188",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.