Provider Demographics
NPI:1396024907
Name:SHAHBAZYAN, HOVHANNES
Entity Type:Individual
Prefix:
First Name:HOVHANNES
Middle Name:
Last Name:SHAHBAZYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 ARDEN AVE
Mailing Address - Street 2:SUITE 112D
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4045
Mailing Address - Country:US
Mailing Address - Phone:818-257-0111
Mailing Address - Fax:818-556-3777
Practice Address - Street 1:417 ARDEN AVE
Practice Address - Street 2:SUITE 112D
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4045
Practice Address - Country:US
Practice Address - Phone:818-257-0111
Practice Address - Fax:818-556-3777
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB9937897343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)