Healthcare Provider Details

I. General information

NPI: 1184772048
Provider Name (Legal Business Name): FLORA ABRAHAMIAN VARDANIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 N MADISON AVE
PASADENA CA
91101-1740
US

IV. Provider business mailing address

94 N MADISON AVE
PASADENA CA
91101-1740
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-4171
  • Fax: 626-792-2328
Mailing address:
  • Phone: 626-792-4171
  • Fax: 626-792-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number261242
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA85631
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA85631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: