Provider Demographics
NPI:1558466763
Name:BARSEGHIAN, ARSEN
Entity Type:Individual
Prefix:
First Name:ARSEN
Middle Name:
Last Name:BARSEGHIAN
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 1:1259 S GLENDALE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3298
Mailing Address - Country:US
Mailing Address - Phone:818-500-9469
Mailing Address - Fax:818-500-9119
Practice Address - Street 1:1259 S GLENDALE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3298
Practice Address - Country:US
Practice Address - Phone:818-500-9469
Practice Address - Fax:818-500-9119
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18120332B00000X
DECF002312335E00000X
CA100982332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02206FMedicaid
4126220001Medicare NSC