Provider Demographics
NPI:1225483001
Name:ZADOURIAN, TEDRIK
Entity Type:Individual
Prefix:
First Name:TEDRIK
Middle Name:
Last Name:ZADOURIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TEDRICK
Other - Middle Name:
Other - Last Name:ZADOURIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10410 PLAINVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-1716
Mailing Address - Country:US
Mailing Address - Phone:818-653-6991
Mailing Address - Fax:
Practice Address - Street 1:10410 PLAINVIEW AVE
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-1716
Practice Address - Country:US
Practice Address - Phone:818-653-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind