Provider Demographics
NPI:1437576055
Name:NENEDZHYAN, ARUTYUN
Entity Type:Individual
Prefix:
First Name:ARUTYUN
Middle Name:
Last Name:NENEDZHYAN
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 1:9720 W PEORIA AVE
Mailing Address - Street 2:110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6131
Mailing Address - Country:US
Mailing Address - Phone:623-262-2309
Mailing Address - Fax:
Practice Address - Street 1:9720 W PEORIA AVE
Practice Address - Street 2:110
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6131
Practice Address - Country:US
Practice Address - Phone:623-262-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL19105332332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies