Provider Demographics
NPI:1932645322
Name:GEVORKYAN, ANDRANIK
Entity Type:Individual
Prefix:MR
First Name:ANDRANIK
Middle Name:
Last Name:GEVORKYAN
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 1:1160 N CENTRAL AVE STE 204
Mailing Address - Street 2:#204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2568
Mailing Address - Country:US
Mailing Address - Phone:818-488-1408
Mailing Address - Fax:818-743-0705
Practice Address - Street 1:1160 N CENTRAL AVE STE 204
Practice Address - Street 2:#204
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2568
Practice Address - Country:US
Practice Address - Phone:818-488-1408
Practice Address - Fax:818-743-0705
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)