Provider Demographics
NPI:1326196809
Name:MOVSESYAN, VARUZHAN (DO)
Entity Type:Individual
Prefix:
First Name:VARUZHAN
Middle Name:
Last Name:MOVSESYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 N 67TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3605
Mailing Address - Country:US
Mailing Address - Phone:623-878-8999
Mailing Address - Fax:623-878-4877
Practice Address - Street 1:17100 N 67TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3605
Practice Address - Country:US
Practice Address - Phone:626-397-5485
Practice Address - Fax:623-878-4877
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9353207R00000X
AZ4681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ235211Medicaid
170771Medicare UPIN
AZ117284Medicare PIN