Provider Demographics
NPI:1477665545
Name:TASHCHYAN, AIDA
Entity Type:Individual
Prefix:PROF
First Name:AIDA
Middle Name:
Last Name:TASHCHYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 RIVERDALE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1469
Mailing Address - Country:US
Mailing Address - Phone:818-956-9130
Mailing Address - Fax:818-240-2335
Practice Address - Street 1:556 RIVERDALE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1469
Practice Address - Country:US
Practice Address - Phone:818-956-9130
Practice Address - Fax:818-240-2335
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
45644332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4596620001Medicare NSC