Provider Demographics
NPI:1457531154
Name:ZARGARIAN, ROUBEN
Entity Type:Individual
Prefix:
First Name:ROUBEN
Middle Name:
Last Name:ZARGARIAN
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 1:150 S GRAND AVE STE H
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4718
Mailing Address - Country:US
Mailing Address - Phone:888-616-0664
Mailing Address - Fax:626-914-5225
Practice Address - Street 1:150 S GRAND AVE STE H
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4718
Practice Address - Country:US
Practice Address - Phone:888-616-0664
Practice Address - Fax:626-914-5225
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102288332B00000X
DECFO02436335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02900FOtherMEDICAL
CA1287880001Medicare NSC