Provider Demographics
NPI:1104079441
Name:SAHRADYAN, ASHOT
Entity type:Individual
Prefix:
First Name:ASHOT
Middle Name:
Last Name:SAHRADYAN
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 1:13064 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2576
Mailing Address - Country:US
Mailing Address - Phone:818-485-0584
Mailing Address - Fax:
Practice Address - Street 1:13064 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2576
Practice Address - Country:US
Practice Address - Phone:818-485-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies