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General NPI Number Information
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NPI Number | 1902418700
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Entity Type | Organization
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Legal Business Name | DJAVAHERIAN MEDICAL PRACTICE PLLC
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 90 HAVEMEYER ST
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City | BROOKLYN
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State | NY
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Zip | 11211-3340
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Country | US
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Telephone | 415-200-2133
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Fax |
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Provider Business Mailing Address
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Address Line | 55 PACIFIC AVE # 101
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-2009
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Country | US
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Telephone | 415-200-2133
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARLEY PAGE
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Credential |
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Telephone | 417-861-9739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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