Provider Demographics
NPI:1023091808
Name:HALEBIAN, JOHN DONALD (DPM CWS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DONALD
Last Name:HALEBIAN
Suffix:
Gender:M
Credentials:DPM CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 N BEACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1801
Mailing Address - Country:US
Mailing Address - Phone:818-508-0177
Mailing Address - Fax:818-566-1829
Practice Address - Street 1:531 N BEACHWOOD DR
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1801
Practice Address - Country:US
Practice Address - Phone:818-508-0177
Practice Address - Fax:818-566-1829
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2819213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28190Medicaid
T19240Medicare UPIN
CA000E28190Medicaid