Provider Demographics
NPI:1033425749
Name:DERGEVORKIAN, ARPINEH B (RD)
Entity Type:Individual
Prefix:MS
First Name:ARPINEH
Middle Name:B
Last Name:DERGEVORKIAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 ROCKLAND PL
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1269
Mailing Address - Country:US
Mailing Address - Phone:818-275-3060
Mailing Address - Fax:
Practice Address - Street 1:4419 ROCKLAND PL
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1269
Practice Address - Country:US
Practice Address - Phone:818-275-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA870128133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered