Provider Demographics
NPI:1265775506
Name:DEMIRCHYAN, GRIGOR (PTA)
Entity type:Individual
Prefix:MR
First Name:GRIGOR
Middle Name:
Last Name:DEMIRCHYAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:GRIGOR
Other - Middle Name:
Other - Last Name:DEMIRCHYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:2360 W ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-0701
Mailing Address - Country:US
Mailing Address - Phone:559-286-6237
Mailing Address - Fax:
Practice Address - Street 1:2360 W ACACIA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-0701
Practice Address - Country:US
Practice Address - Phone:559-286-6237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9880374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide