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General NPI Number Information
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NPI Number | 1407085665
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Entity Type | Individual
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Provider Name | MIRNA DEMIRDJIAN MD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 2501 E CHAPMAN AVE STE 107
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City | FULLERTON
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State | CA
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Zip | 92831-3135
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Country | US
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Telephone | 714-409-6881
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Fax | 480-422-8886
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Provider Business Mailing Address
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Address Line | 8064 DORADO CIR
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City | LONG BEACH
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State | CA
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Zip | 90808-1969
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Country | US
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Telephone | 714-409-6881
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Fax | 480-422-8886
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 42234
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C162232
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License Number State | CA
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