Provider Demographics
NPI:1801307145
Name:SEMIRDZJIAN, MARTIROS MARTIN
Entity type:Individual
Prefix:
First Name:MARTIROS
Middle Name:MARTIN
Last Name:SEMIRDZJIAN
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 1:313 EAST BROADWAY
Mailing Address - Street 2:#214
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:313 EAST BROADWAY
Practice Address - Street 2:#214
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91209
Practice Address - Country:US
Practice Address - Phone:818-400-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)