MEDICARE: V NAVASARDIAN MD INC

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	174400000X	Specialist	A69393	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W16795	OTHER	CA	MEDICARE GROUP ID

General Provider Information

NPI Number	:	1225219769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	V NAVASARDIAN MD INC

Provider Business Mailing Address
First Line	:	1546 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2657
Country	:	US
Telephone Number	:	626-791-2552
Fax Number	:	625-791-2506

Provider Business Practice Location Address
First Line	:	1546 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2657
Country	:	US
Telephone Number	:	626-791-2552
Fax Number	:	625-791-2506

Authorized Official
Title or Position	:	CEO
Name	:	DR. VIOLETA M NAVASARDIAN
Credential	:	M.D.
Telephone Number	:	626-791-2552

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	12/11/2023

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