Healthcare Provider Details

I. General information

NPI: 1831084722
Provider Name (Legal Business Name): RAFAEL RAFIK GEVORKYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 ZONAL AVE
LOS ANGELES CA
90089-5601
US

IV. Provider business mailing address

5111 MELVIN AVE
TARZANA CA
91356-3802
US

V. Phone/Fax

Practice location:
  • Phone: 818-317-1485
  • Fax:
Mailing address:
  • Phone: 818-317-1485
  • Fax: 818-317-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: