Provider Demographics
NPI:1932137023
Name:KESHISHYAN, VARDUSH (MA)
Entity Type:Individual
Prefix:
First Name:VARDUSH
Middle Name:
Last Name:KESHISHYAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 RETA ST
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1252
Mailing Address - Country:US
Mailing Address - Phone:818-726-2279
Mailing Address - Fax:
Practice Address - Street 1:3323 RETA ST
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1252
Practice Address - Country:US
Practice Address - Phone:818-726-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2379231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist