MEDICARE: MR. VAHE VARDANIAN

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1417114125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VAHE VARDANIAN

Provider Business Mailing Address
First Line	:	6515 VAN NUYS BLVD
Second Line	:	SUITE M
City	:	VAN NUYS
State	:	CA
Zip	:	91401-1425
Country	:	US
Telephone Number	:	818-908-8393
Fax Number	:	818-908-0320

Provider Business Practice Location Address
First Line	:	6515 VAN NUYS BLVD
Second Line	:	SUITE M
City	:	VAN NUYS
State	:	CA
Zip	:	91401-1425
Country	:	US
Telephone Number	:	818-908-8393
Fax Number	:	818-908-0320

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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Directions to “ MR. VAHE VARDANIAN ” Practice Location

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