Provider Demographics
NPI:1851910665
Name:GHAZARYAN, HOVHANNES (MD)
Entity Type:Individual
Prefix:DR
First Name:HOVHANNES
Middle Name:
Last Name:GHAZARYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HOVHANNES
Other - Middle Name:
Other - Last Name:GHAZARYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:400 N PEPPER AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1819
Mailing Address - Country:US
Mailing Address - Phone:818-651-1177
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE STE 107
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1819
Practice Address - Country:US
Practice Address - Phone:909-580-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program