Healthcare Provider Details

I. General information

NPI: 1275978876
Provider Name (Legal Business Name): ARMEN DERIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 S ELLSWORTH RD STE 109
MESA AZ
85212-2165
US

IV. Provider business mailing address

1319 E TREASURE COVE DR
GILBERT AZ
85234-2672
US

V. Phone/Fax

Practice location:
  • Phone: 480-597-4321
  • Fax: 833-559-0886
Mailing address:
  • Phone: 818-425-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME124991
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number53494
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME124991
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME24991
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number53494
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number53494
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: