MEDICARE: DR. SEVAN GARBOUSHIAN DO

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	207Q00000X	Family Medicine Physician	20A7703	CA

General Provider Information

NPI Number	:	1376552802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEVAN GARBOUSHIAN DO

Provider Business Mailing Address
First Line	:	393 E WALNUT ST
Second Line	:	3RD FLOOR SE PHRS
City	:	PASADENA
State	:	CA
Zip	:	91188-0001
Country	:	US
Telephone Number	:	626-405-7914
Fax Number	:

Provider Business Practice Location Address
First Line	:	393 E WALNUT ST
Second Line	:	3RD FLOOR SE PHRS
City	:	PASADENA
State	:	CA
Zip	:	91188-0001
Country	:	US
Telephone Number	:	626-405-7914
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/13/2021

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