Provider Demographics
NPI:1174814701
Name:DERHOVANESSIAN, ARISS (MD)
Entity Type:Individual
Prefix:DR
First Name:ARISS
Middle Name:
Last Name:DERHOVANESSIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARISS
Other - Middle Name:
Other - Last Name:DER HOVANESSIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:UCLA CENTER FOR HEALTH SCIENCES 37-131, BOX 951690
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1690
Mailing Address - Country:US
Mailing Address - Phone:310-825-8599
Mailing Address - Fax:310-794-7073
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:UCLA CENTER FOR HEALTH SCIENCES 37-131, BOX 951690
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1690
Practice Address - Country:US
Practice Address - Phone:310-825-8599
Practice Address - Fax:310-794-7073
Is Sole Proprietor?:No
Enumeration Date:2011-04-30
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100344207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174814701Medicaid
CAGE635ZMedicare PIN