Provider Demographics
NPI:1841517349
Name:ASA BROS INC
Entity type:Organization
Organization Name:ASA BROS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZICHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:866-323-8911
Mailing Address - Street 1:16011 BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4806
Mailing Address - Country:US
Mailing Address - Phone:866-323-8611
Mailing Address - Fax:818-908-0894
Practice Address - Street 1:16011 BASSETT ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4806
Practice Address - Country:US
Practice Address - Phone:866-323-8611
Practice Address - Fax:818-908-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197607450305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service