Provider Demographics
NPI:1659930725
Name:BOYADZHYAN, ARMEN MIKE
Entity Type:Individual
Prefix:
First Name:ARMEN
Middle Name:MIKE
Last Name:BOYADZHYAN
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 1:17626 TULSA ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4612
Mailing Address - Country:US
Mailing Address - Phone:818-318-4040
Mailing Address - Fax:
Practice Address - Street 1:17626 TULSA ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4612
Practice Address - Country:US
Practice Address - Phone:818-318-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
CA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02281981Medicaid