MEDICARE: VIOLETA M NAVASARDIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0101X	Anatomic Pathology Physician	A69393	CA
2	208D00000X	General Practice Physician	A69393	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W16795	OTHER	CA	MEDICARE GROUP ID

General Provider Information

NPI Number	:	1073650925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIOLETA M NAVASARDIAN M.D.

Provider Business Mailing Address
First Line	:	1546 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2657
Country	:	US
Telephone Number	:	626-791-2552
Fax Number	:	626-791-2506

Provider Business Practice Location Address
First Line	:	1546 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2657
Country	:	US
Telephone Number	:	626-791-2552
Fax Number	:	626-791-2506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	10/01/2007

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