Provider Demographics
NPI:1700338951
Name:GEZALIAN, HOVANES
Entity Type:Individual
Prefix:
First Name:HOVANES
Middle Name:
Last Name:GEZALIAN
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 1:545 N HELIOTROPE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-2905
Mailing Address - Country:US
Mailing Address - Phone:323-896-4543
Mailing Address - Fax:
Practice Address - Street 1:5836 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1058
Practice Address - Country:US
Practice Address - Phone:562-461-3998
Practice Address - Fax:562-920-3087
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor