Basic Information
| Provider Information | |||||||||
| NPI: | 1902075203 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIABETES & ENDOCRINOLOGY CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 W GLENOAKS BLVD STE 10 | ||||||||
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| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912024039 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1812 VERDUGO BLVD | ||||||||
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| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912081407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187907100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2008 | ||||||||
| LastUpdateDate: | 08/31/2009 | ||||||||
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| AuthorizedOfficialLastName: | NARIYANTS | ||||||||
| AuthorizedOfficialFirstName: | JHANNA | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDRA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8182590777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 20A9323 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 1629163035 | 01 | NPI NUMBER | OTHER |