Provider Demographics
NPI:1285713644
Name:TADEVOSYAN, NVER SR
Entity type:Individual
Prefix:MR
First Name:NVER
Middle Name:
Last Name:TADEVOSYAN
Suffix:SR
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 1:1507 DOCKERY AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-9332
Mailing Address - Country:US
Mailing Address - Phone:559-230-7360
Mailing Address - Fax:559-897-5266
Practice Address - Street 1:1507 DOCKERY AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-9332
Practice Address - Country:US
Practice Address - Phone:559-230-7360
Practice Address - Fax:559-897-5266
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD2737440172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver