Healthcare Provider Details

I. General information

NPI: 1154335040
Provider Name (Legal Business Name): MICHAEL A AVAKIAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 E WASHINGTON BLVD SUITE C
PASADENA CA
91107-1465
US

IV. Provider business mailing address

2544 E WASHINGTON BLVD SUITE C
PASADENA CA
91107-1452
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-4069
  • Fax: 626-798-9041
Mailing address:
  • Phone: 626-398-4069
  • Fax: 626-798-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3953
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: