Provider Demographics
NPI:1093129785
Name:ADRINE YADEGARIAN, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ADRINE YADEGARIAN, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YADEGARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-550-1965
Mailing Address - Street 1:411 N CENTRAL AVE
Mailing Address - Street 2:#130
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2081
Mailing Address - Country:US
Mailing Address - Phone:818-550-1965
Mailing Address - Fax:818-550-1966
Practice Address - Street 1:411 N CENTRAL AVE
Practice Address - Street 2:#130
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2081
Practice Address - Country:US
Practice Address - Phone:818-550-1965
Practice Address - Fax:818-550-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty