Provider Demographics
NPI:1164515086
Name:EUREDJIAN, CECILIA B (PA)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:B
Last Name:EUREDJIAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:DR
Other - First Name:CECILIA
Other - Middle Name:B
Other - Last Name:EUREDJIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:28511 OAK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3059
Mailing Address - Country:US
Mailing Address - Phone:661-775-4875
Mailing Address - Fax:661-775-4876
Practice Address - Street 1:10515 BALBOA BLVD STE 390
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6373
Practice Address - Country:US
Practice Address - Phone:818-366-8112
Practice Address - Fax:818-366-6002
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27427111NN1001X
CA17728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111NN1001XChiropractic ProvidersChiropractorNutrition