MEDICARE: DR. ARISS DERHOVANESSIAN M.D.

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
1	207RP1001X	Pulmonary Disease Physician	A100344	CA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	A100344	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174814701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARISS DERHOVANESSIAN M.D.

Provider Business Mailing Address
First Line	:	10833 LE CONTE AVE
Second Line	:	UCLA CENTER FOR HEALTH SCIENCES 37-131, BOX 951690
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1690
Country	:	US
Telephone Number	:	310-825-8599
Fax Number	:	310-794-7073

Provider Business Practice Location Address
First Line	:	10833 LE CONTE AVE
Second Line	:	UCLA CENTER FOR HEALTH SCIENCES 37-131, BOX 951690
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-1690
Country	:	US
Telephone Number	:	310-825-8599
Fax Number	:	310-794-7073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2011
Last Update Date	:	09/24/2012

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Directions to “ DR. ARISS DERHOVANESSIAN M.D.” Practice Location

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