Provider Demographics
NPI:1457458796
Name:YEREVANIAN, BOGHOS I (MD)
Entity Type:Individual
Prefix:DR
First Name:BOGHOS
Middle Name:I
Last Name:YEREVANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23300 PARK HACIENDA
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1715
Mailing Address - Country:US
Mailing Address - Phone:818-410-5398
Mailing Address - Fax:818-223-9277
Practice Address - Street 1:16111 PLUMMER (116A)
Practice Address - Street 2:PSYCHIATRY DEPARTMENT BLDG 10
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:818-223-9277
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC408532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC40853Medicare ID - Type UnspecifiedMEDICARE NUMBER