Provider Demographics
NPI:1457943862
Name:ONE HEALTH MEDICAL
Entity Type:Organization
Organization Name:ONE HEALTH MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:VARUZHAN
Authorized Official - Last Name:DERDERYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-552-1547
Mailing Address - Street 1:4955 VAN NUYS BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1811
Mailing Address - Country:US
Mailing Address - Phone:773-412-4653
Mailing Address - Fax:
Practice Address - Street 1:1008 W AVENUE M14
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1441
Practice Address - Country:US
Practice Address - Phone:773-412-4653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health