Provider Demographics
NPI:1215994561
Name:NAZARIAN, SERJIK (DPM)
Entity type:Individual
Prefix:
First Name:SERJIK
Middle Name:
Last Name:NAZARIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S CALVARY WAY
Mailing Address - Street 2:STE A
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4165
Mailing Address - Country:US
Mailing Address - Phone:928-282-3305
Mailing Address - Fax:928-282-6816
Practice Address - Street 1:401 S CALVARY WAY
Practice Address - Street 2:STE A
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4165
Practice Address - Country:US
Practice Address - Phone:928-282-3305
Practice Address - Fax:928-282-6816
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0380213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ149262Medicaid
AZZ69198Medicare PIN
AZU35456Medicare UPIN