Provider Demographics
NPI:1306249719
Name:ATANESYAN, GEGHAM
Entity type:Individual
Prefix:MR
First Name:GEGHAM
Middle Name:
Last Name:ATANESYAN
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 1:2938 E NILES AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4960
Mailing Address - Country:US
Mailing Address - Phone:559-348-7989
Mailing Address - Fax:559-297-4104
Practice Address - Street 1:2938 E NILES AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-4960
Practice Address - Country:US
Practice Address - Phone:559-348-7989
Practice Address - Fax:559-297-4104
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8V90774343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA9850966OtherWORKERS COMPENSATION