Provider Demographics
NPI:1417443136
Name:ALEXANDRIAN, ARTIN
Entity Type:Individual
Prefix:
First Name:ARTIN
Middle Name:
Last Name:ALEXANDRIAN
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 1:510 S GRAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4291
Mailing Address - Country:US
Mailing Address - Phone:626-914-1980
Mailing Address - Fax:
Practice Address - Street 1:510 S GRAND AVE STE 400
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4207
Practice Address - Country:US
Practice Address - Phone:626-914-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009349363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health