Healthcare Provider Details

I. General information

NPI: 1346504628
Provider Name (Legal Business Name): ALEXANDER G. GEVORGYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KAREN GEVORGYAN MD

II. Dates (important events)

Enumeration Date: 07/01/2012
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 S GLENDALE AVE
GLENDALE CA
91205-3349
US

IV. Provider business mailing address

1332 S GLENDALE AVE
GLENDALE CA
91205-3349
US

V. Phone/Fax

Practice location:
  • Phone: 818-649-9232
  • Fax: 818-696-0922
Mailing address:
  • Phone: 818-649-9232
  • Fax: 818-696-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA133154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: