Provider Demographics
NPI:1891299525
Name:TATEOSIAN, GARO
Entity type:Individual
Prefix:
First Name:GARO
Middle Name:
Last Name:TATEOSIAN
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 1:4094 W CORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4694
Mailing Address - Country:US
Mailing Address - Phone:559-917-2102
Mailing Address - Fax:
Practice Address - Street 1:4094 W CORTLAND AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4694
Practice Address - Country:US
Practice Address - Phone:559-917-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherTIN