Provider Demographics
NPI:1609962026
Name:DIKRANIAN, ARA HAGOP (MD)
Entity type:Individual
Prefix:DR
First Name:ARA
Middle Name:HAGOP
Last Name:DIKRANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3633 CAMINO DEL RIO S STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4014
Mailing Address - Country:US
Mailing Address - Phone:619-287-9730
Mailing Address - Fax:619-398-1869
Practice Address - Street 1:3633 CAMINO DEL RIO S STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4014
Practice Address - Country:US
Practice Address - Phone:619-287-9730
Practice Address - Fax:619-398-1869
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA062403174400000X
CAA62403207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A624030Medicaid
CAH76195Medicare UPIN
CA00A624030Medicaid