Basic Information
| Provider Information | |||||||||
| NPI: | 1912238866 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALEXANDER M MAJIDIAN M D A PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 951 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912090951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185500900 | ||||||||
| FaxNumber: | 8185500909 | ||||||||
| Practice Location | |||||||||
| Address1: | 4929 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189817111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2010 | ||||||||
| LastUpdateDate: | 06/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | MEHRER | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8185500900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | A61101 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | A61101 | 01 | CA | BLUE CROSS | OTHER | 00A611012 | 01 | CA | BLUE SHIELD | OTHER |