Healthcare Provider Details

I. General information

NPI: 1073328266
Provider Name (Legal Business Name): ERIC DAVARHANIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 03/19/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 N PASADENA AVE FL 8
PASADENA CA
91103-3670
US

IV. Provider business mailing address

74 N PASADENA AVE FL 8
PASADENA CA
91103-3670
US

V. Phone/Fax

Practice location:
  • Phone: 626-381-1102
  • Fax:
Mailing address:
  • Phone: 626-381-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: