Healthcare Provider Details

I. General information

NPI: 1861805814
Provider Name (Legal Business Name): JOHN TED DJABRAYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 W ASHLAN AVE
FRESNO CA
93722-4307
US

IV. Provider business mailing address

4711 W ASHLAN AVE
FRESNO CA
93722-4307
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-6660
  • Fax:
Mailing address:
  • Phone: 559-203-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA136184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: