Healthcare Provider Details

I. General information

NPI: 1285213884
Provider Name (Legal Business Name): ASHOT OGANESYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 SW 67TH AVE APT L15
MIAMI FL
33155-5869
US

IV. Provider business mailing address

4708 SW 67TH AVE APT L15
MIAMI FL
33155-5869
US

V. Phone/Fax

Practice location:
  • Phone: 818-245-2883
  • Fax:
Mailing address:
  • Phone: 818-245-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4526
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: