Provider Demographics
NPI:1255520177
Name:ALAVERDYAN, MGER
Entity type:Individual
Prefix:MR
First Name:MGER
Middle Name:
Last Name:ALAVERDYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MHER
Other - Middle Name:
Other - Last Name:ALAVERDYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:315 W ALAMEDA AVE # 7
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-3352
Mailing Address - Country:US
Mailing Address - Phone:818-260-8710
Mailing Address - Fax:
Practice Address - Street 1:12450 VAN NUYS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1391
Practice Address - Country:US
Practice Address - Phone:818-896-1161
Practice Address - Fax:818-896-5096
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7068Medicaid
CA7420Medicaid