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Licensing details for: PTL 13568

Name: MAKARYAN, TADEVOS TODD

License Type: Postgraduate Training License

Primary Status: License Canceled Primary Status Definition

School Name: Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine

Graduation Year: 2023

Current Enrolled Postgraduate Training Program

Facility Name: HCA HEALTHCARE/LOS ROBLES REGIONAL MEDICAL CENTER PROGRAM

City: Thousand Oaks

State: California

Speciality: Surgery

Start Date: 07/01/2023

Anticipated End Date: 08/20/2024

Address of Record

12612 Gilmore St
NORTH HOLLYWOOD CA 91606-1245
LOS ANGELES county
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Issuance Date

December 12, 2023

Expiration Date

N/A

Current Date / Time

April 14, 2026
1:49:10 PM

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License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Postgraduate Training License

Related Party Role: Physician & Surgeon

Name: MAKARYAN, TADEVOS TODD

License/Registration Type: Physician's and Surgeon's

License Number: 204923 Primary Status: License Renewed & Current

Address :
12612 Gilmore St
NORTH HOLLYWOOD CA 91606-1245
LOS ANGELES COUNTY

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