Provider Demographics
NPI:1205024221
Name:GAZARIAN, VARDAN V (CPO)
Entity Type:Individual
Prefix:
First Name:VARDAN
Middle Name:V
Last Name:GAZARIAN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 S FAIR OAKS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2654
Mailing Address - Country:US
Mailing Address - Phone:626-403-8174
Mailing Address - Fax:
Practice Address - Street 1:1035 S FAIR OAKS AVE STE 102
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2654
Practice Address - Country:US
Practice Address - Phone:626-403-8174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist