Provider Demographics
NPI:1508420589
Name:MADATYAN, ARGISHTI
Entity Type:Individual
Prefix:MR
First Name:ARGISHTI
Middle Name:
Last Name:MADATYAN
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 1:10639 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2512
Mailing Address - Country:US
Mailing Address - Phone:818-980-1927
Mailing Address - Fax:818-980-1928
Practice Address - Street 1:10639 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2512
Practice Address - Country:US
Practice Address - Phone:818-980-1927
Practice Address - Fax:818-980-1928
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPED3716224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist