MEDICARE: HOVHANNES SHAHBAZYAN

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	343900000X	Non-emergency Medical Transport (VAN)	B9937897	CA

General Provider Information

NPI Number	:	1396024907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOVHANNES SHAHBAZYAN

Provider Business Mailing Address
First Line	:	417 ARDEN AVE
Second Line	:	SUITE 112D
City	:	GLENDALE
State	:	CA
Zip	:	91203-4045
Country	:	US
Telephone Number	:	818-257-0111
Fax Number	:	818-556-3777

Provider Business Practice Location Address
First Line	:	417 ARDEN AVE
Second Line	:	SUITE 112D
City	:	GLENDALE
State	:	CA
Zip	:	91203-4045
Country	:	US
Telephone Number	:	818-257-0111
Fax Number	:	818-556-3777

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

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	02/27/2012

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