Healthcare Provider Details

I. General information

NPI: 1174730576
Provider Name (Legal Business Name): VAZGEN ARAM MADOYAN SR. L.AC.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S MENTOR AVE 300
PASADENA CA
91106-2927
US

IV. Provider business mailing address

34 S MENTOR AVE 300
PASADENA CA
91106-2927
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-8798
  • Fax:
Mailing address:
  • Phone: 626-564-8798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: