Provider Demographics
NPI:1194054015
Name:YAVROUIAN, ERIC J (M D)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:YAVROUIAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WILSON TER
Mailing Address - Street 2:SUITE 270
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4071
Mailing Address - Country:US
Mailing Address - Phone:818-241-2101
Mailing Address - Fax:818-241-2166
Practice Address - Street 1:1505 WILSON TERRACE
Practice Address - Street 2:270
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4078
Practice Address - Country:US
Practice Address - Phone:818-241-2101
Practice Address - Fax:818-241-2166
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA110286207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0088300Medicaid
W14884Medicare PIN