Healthcare Provider Details

I. General information

NPI: 1477230274
Provider Name (Legal Business Name): GEORGE BEDARIAN LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SKYWAY DR
CAMARILLO CA
93010-8552
US

IV. Provider business mailing address

331 AZALEA ST
FILLMORE CA
93015-2241
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-1155
  • Fax: 805-383-1134
Mailing address:
  • Phone: 323-479-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number252428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: