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NPI Code Detail

MEDICARE: VARDAN DAGSTANYAN DO, MBA

MEDICARE: VARDAN DAGSTANYAN DO, MBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1124867163
Entity Type Code : Individual
Provider Name (Legal Business Name) : VARDAN DAGSTANYAN DO, MBA
Provider Business Mailing Address
First Line : 1601 PRECISION PARK LN
Second Line :
City : SAN YSIDRO
State : CA
Zip : 92173-1345
Country : US
Telephone Number : 619-734-0621
Fax Number :
Provider Business Practice Location Address
First Line : 4004 BEYER BLVD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92173-2099
Country : US
Telephone Number : 619-227-0450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2024
Last Update Date : 06/25/2024

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Directions to “ VARDAN DAGSTANYAN DO, MBA” Practice Location

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