Provider Demographics
NPI:1922535731
Name:NAZARYAN, EMIL
Entity Type:Individual
Prefix:MR
First Name:EMIL
Middle Name:
Last Name:NAZARYAN
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 1:1407 FOOTHILL BLVD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3451
Mailing Address - Country:US
Mailing Address - Phone:818-415-1522
Mailing Address - Fax:
Practice Address - Street 1:2123 FOOTHILL BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2954
Practice Address - Country:US
Practice Address - Phone:818-415-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty