Healthcare Provider Details

I. General information

NPI: 1497073084
Provider Name (Legal Business Name): ARTUR VARDANYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE STE 308
GLENDALE CA
91204-4644
US

IV. Provider business mailing address

800 S CENTRAL AVE STE 308
GLENDALE CA
91204-4644
US

V. Phone/Fax

Practice location:
  • Phone: 818-549-8800
  • Fax: 818-549-8811
Mailing address:
  • Phone: 818-549-8800
  • Fax: 818-549-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberME105695
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME 105695
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA127250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: