Provider Demographics
NPI:1184675175
Name:DAVTIAN, ASTRIK (MD)
Entity Type:Individual
Prefix:DR
First Name:ASTRIK
Middle Name:
Last Name:DAVTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W EULALIA ST
Mailing Address - Street 2:301
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2849
Mailing Address - Country:US
Mailing Address - Phone:818-240-0108
Mailing Address - Fax:818-240-0301
Practice Address - Street 1:222 W EULALIA ST
Practice Address - Street 2:301
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2849
Practice Address - Country:US
Practice Address - Phone:818-240-0108
Practice Address - Fax:818-240-0301
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A540920Medicaid
CAA54092Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAG57645Medicare UPIN