Healthcare Provider Details

I. General information

NPI: 1003586215
Provider Name (Legal Business Name): GEORGE BOYADJIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 E ASHLAN AVE
FRESNO CA
93726-3102
US

IV. Provider business mailing address

2329 E ASHLAN AVE
FRESNO CA
93726-3102
US

V. Phone/Fax

Practice location:
  • Phone: 559-917-5336
  • Fax:
Mailing address:
  • Phone: 559-917-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI48730925
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: