Provider Demographics
NPI:1265602254
Name:MICHAEL A. AVAKIAN, D.P.M.
Entity type:Organization
Organization Name:MICHAEL A. AVAKIAN, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:AVAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-398-4069
Mailing Address - Street 1:2544 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1452
Mailing Address - Country:US
Mailing Address - Phone:626-398-4069
Mailing Address - Fax:626-798-9041
Practice Address - Street 1:2544 E WASHINGTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1452
Practice Address - Country:US
Practice Address - Phone:626-398-4069
Practice Address - Fax:626-798-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3953332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E39530Medicaid
U52874Medicare UPIN
CA1118530001Medicare NSC
E3953Medicare PIN