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General NPI Number Information
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NPI Number | 1457458796
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Entity Type | Individual
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Provider Name | BOGHOS I. YEREVANIAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16111 PLUMMER (116A) PSYCHIATRY DEPARTMENT BLDG 10
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City | NORTH HILLS
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State | CA
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Zip | 91343
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Country | US
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Telephone | 818-891-7711
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Fax | 818-223-9277
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Provider Business Mailing Address
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Address Line | 23300 PARK HACIENDA
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City | CALABASAS
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State | CA
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Zip | 91302-1715
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Country | US
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Telephone | 818-410-5398
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Fax | 818-223-9277
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C40853
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License Number State | CA
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