Provider Demographics
NPI:1417114125
Name:VARDANIAN, VAHE
Entity Type:Individual
Prefix:MR
First Name:VAHE
Middle Name:
Last Name:VARDANIAN
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 1:6515 VAN NUYS BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1425
Mailing Address - Country:US
Mailing Address - Phone:818-908-8393
Mailing Address - Fax:818-908-0320
Practice Address - Street 1:6515 VAN NUYS BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1425
Practice Address - Country:US
Practice Address - Phone:818-908-8393
Practice Address - Fax:818-908-0320
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies