MEDICARE: MARCAR SHADAREVIAN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790966760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCAR SHADAREVIAN

Provider Business Mailing Address
First Line	:	2837 HONOLULU AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91214
Country	:	US
Telephone Number	:	818-244-5497
Fax Number	:	818-244-2822

Provider Business Practice Location Address
First Line	:	2837 HONOLULU AVE.
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91214
Country	:	US
Telephone Number	:	818-244-5497
Fax Number	:	818-244-2822

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

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	12/19/2022

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Directions to “ MARCAR SHADAREVIAN ” Practice Location

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