Healthcare Provider Details

I. General information

NPI: 1801069851
Provider Name (Legal Business Name): TASHCHYAN SHOE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 RIVERDALE DR
GLENDALE CA
91204-1469
US

IV. Provider business mailing address

556 RIVERDALE DR
GLENDALE CA
91204-1469
US

V. Phone/Fax

Practice location:
  • Phone: 818-956-9130
  • Fax: 818-240-2335
Mailing address:
  • Phone: 818-956-9130
  • Fax: 818-240-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: GEVORK TASHCHYAN
Title or Position: OWNER
Credential:
Phone: 818-956-9130