Provider Demographics
NPI:1497940704
Name:AVAKIAN, FREDERICK (DPM)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:AVAKIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23206 LYONS AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2667
Mailing Address - Country:US
Mailing Address - Phone:661-288-2321
Mailing Address - Fax:661-288-0378
Practice Address - Street 1:23206 LYONS AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2667
Practice Address - Country:US
Practice Address - Phone:661-288-2321
Practice Address - Fax:661-288-0378
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4191213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16338Medicare PIN
CAU73271Medicare UPIN