Provider Demographics
NPI:1578820122
Name:AYVAZYAN, GOHAR (PA-C)
Entity Type:Individual
Prefix:
First Name:GOHAR
Middle Name:
Last Name:AYVAZYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 N BEDFORD DR STE 212
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4321
Mailing Address - Country:US
Mailing Address - Phone:310-858-5090
Mailing Address - Fax:310-888-0015
Practice Address - Street 1:435 N BEDFORD DR STE 312
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4314
Practice Address - Country:US
Practice Address - Phone:310-858-5090
Practice Address - Fax:310-276-5508
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant