Healthcare Provider Details

I. General information

NPI: 1649680471
Provider Name (Legal Business Name): ARARAT ANDRE AVETISYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

17611 LUDLOW ST
GRANADA HILLS CA
91344-4605
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2202
  • Fax:
Mailing address:
  • Phone: 818-488-9143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA144458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: