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General NPI Number Information
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NPI Number | 1891675674
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Entity Type | Organization
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Legal Business Name | AXODERM CORP
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 1510 S CENTRAL AVE STE 640
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City | GLENDALE
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State | CA
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Zip | 91204-2552
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Country | US
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Telephone | 310-933-5054
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Fax | 310-935-3367
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Provider Business Mailing Address
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Address Line | 1510 S CENTRAL AVE STE 640
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City | GLENDALE
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State | CA
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Zip | 91204-2552
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Country | US
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Telephone | 310-933-5054
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Fax | 310-935-3367
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Authorized Official
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Title or Position | OFFICE MANAGER / EXECUTIVE
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Name | ANGIE DAVOODY
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Credential |
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Telephone | 818-242-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PT0002X
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Taxonomy Name | Medical Toxicology (Emergency Medicine) Physician
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License Number |
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License Number State |
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