Healthcare Provider Details

I. General information

NPI: 1700631215
Provider Name (Legal Business Name): DAVIT SEDRAKYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16843 CITRONIA ST
NORTHRIDGE CA
91343-1705
US

IV. Provider business mailing address

16843 CITRONIA ST
NORTHRIDGE CA
91343-1705
US

V. Phone/Fax

Practice location:
  • Phone: 424-999-0999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: