Provider Demographics
NPI:1063638625
Name:VARDANIAN, ARMEN (LAC)
Entity Type:Individual
Prefix:MR
First Name:ARMEN
Middle Name:
Last Name:VARDANIAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 CHESTER ST
Mailing Address - Street 2:APT O
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1535
Mailing Address - Country:US
Mailing Address - Phone:818-731-8624
Mailing Address - Fax:818-548-9209
Practice Address - Street 1:327 CHESTER ST
Practice Address - Street 2:APT O
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1535
Practice Address - Country:US
Practice Address - Phone:818-731-8624
Practice Address - Fax:818-548-9209
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11498171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist