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General NPI Number Information
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NPI Number | 1265440366
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Entity Type | Individual
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Provider Name | HRATCH DEMIRJIAN D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 1257 W SAN BERNARDINO RD
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City | COVINA
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State | CA
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Zip | 91722-3509
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Country | US
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Telephone | 626-331-7391
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Fax | 626-339-0613
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Provider Business Mailing Address
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Address Line | PO BOX 1980
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City | COVINA
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State | CA
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Zip | 91722-0980
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Country | US
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Telephone | 626-331-7391
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Fax | 626-339-0613
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E3993
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License Number State | CA
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