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General NPI Number Information
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NPI Number | 1174704597
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Entity Type | Individual
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Provider Name | VARTAN MINASYAN
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Gender | Male
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 11082 COLOMA RD SUITE #10
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-2875
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Country | US
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Telephone | 916-638-2363
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Fax | 916-638-2364
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Provider Business Mailing Address
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Address Line | 11082 COLOMA RD SUITE #10
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-2875
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Country | US
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Telephone | 916-638-2363
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Fax | 916-638-2364
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 101072
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License Number State | CA
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