Provider Demographics
NPI:1699289660
Name:ALEXANDER G GEVORGYAN MD INC
Entity type:Organization
Organization Name:ALEXANDER G GEVORGYAN MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO - PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:G
Authorized Official - Last Name:GEVORGYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-649-9232
Mailing Address - Street 1:1332 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3349
Mailing Address - Country:US
Mailing Address - Phone:818-649-9232
Mailing Address - Fax:818-696-0922
Practice Address - Street 1:1332 S GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3349
Practice Address - Country:US
Practice Address - Phone:818-649-9232
Practice Address - Fax:818-696-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133154261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty