Provider Demographics
NPI:1710158944
Name:SHAVERDIAN, ARMIN (PT)
Entity Type:Individual
Prefix:
First Name:ARMIN
Middle Name:
Last Name:SHAVERDIAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23931 WANIGAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4205
Mailing Address - Country:US
Mailing Address - Phone:619-818-1704
Mailing Address - Fax:619-568-3313
Practice Address - Street 1:7644 VOLCLAY DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1220
Practice Address - Country:US
Practice Address - Phone:858-412-9349
Practice Address - Fax:619-568-3313
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-15
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist