Provider Demographics
NPI:1033270293
Name:ABRAHAMIAN, AZNIV A (MD)
Entity Type:Individual
Prefix:DR
First Name:AZNIV
Middle Name:A
Last Name:ABRAHAMIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12507 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3135
Mailing Address - Country:US
Mailing Address - Phone:818-769-7540
Mailing Address - Fax:818-769-0612
Practice Address - Street 1:12507 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3135
Practice Address - Country:US
Practice Address - Phone:818-769-7540
Practice Address - Fax:818-769-0612
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50782208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF43111Medicare UPIN
CAA50782Medicare ID - Type Unspecified