Provider Demographics
NPI:1881009108
Name:R AJAKWE MD AND R TATEVOSSIAN MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:R AJAKWE MD AND R TATEVOSSIAN MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:TATEVOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-325-2066
Mailing Address - Street 1:201 S BUENA VISTA ST
Mailing Address - Street 2:SUITE 238
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4569
Mailing Address - Country:US
Mailing Address - Phone:818-325-2088
Mailing Address - Fax:818-325-2096
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:SUITE 238
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4569
Practice Address - Country:US
Practice Address - Phone:818-325-2088
Practice Address - Fax:818-325-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty