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General NPI Number Information
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NPI Number | 1316126618
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Entity Type | Organization
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Legal Business Name | LORIS YADEGARIAN DPM
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 14600 SHERMAN WAY SUITE 210
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City | VAN NUYS
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State | CA
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Zip | 91405-2269
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Country | US
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Telephone | 818-988-6880
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Fax | 818-988-3289
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Provider Business Mailing Address
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Address Line | 14600 SHERMAN WAY SUITE 210
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City | VAN NUYS
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State | CA
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Zip | 91405-2269
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Country | US
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Telephone | 818-988-6880
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Fax | 818-988-3289
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. LORIS YADEGARIAN
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Credential | DPM
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Telephone | 818-988-6880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4376
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License Number State | CA
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