Healthcare Provider Details

I. General information

NPI: 1245794866
Provider Name (Legal Business Name): ALLERGY AND ASTHMA SPECIALIST DOCTORS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
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

1131 N PACIFIC AVE
GLENDALE CA
91202-2358
US

V. Phone/Fax

Practice location:
  • Phone: 818-558-5828
  • Fax: 888-717-1542
Mailing address:
  • Phone: 818-558-5828
  • Fax: 888-717-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARINE DEMIRJIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 818-558-5828