Provider Demographics
NPI:1992759369
Name:HACOPIAN, AVA (MD)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:HACOPIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 GRAEBER STREET , SUITE 9
Mailing Address - Street 2:163RD MDG MARCH AIR RESERVE BASE/
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92518
Mailing Address - Country:US
Mailing Address - Phone:916-854-3000
Mailing Address - Fax:
Practice Address - Street 1:1620 GRAEBER STREET , SUITE 9
Practice Address - Street 2:163RD MDG MARCH AIR RESERVE BASE/
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92518
Practice Address - Country:US
Practice Address - Phone:916-854-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11784207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A632960Medicaid
CAH04426Medicare UPIN
CA00A632960Medicaid