MEDICARE: CHRISTINE AYVAZYAN PA

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	363AM0700X	Medical Physician Assistant	PA 16368	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA 16368	OTHER	CA	PA LISENSE

General Provider Information

NPI Number	:	1457372542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE AYVAZYAN PA

Provider Business Mailing Address
First Line	:	1500 S CENTRAL AVE
Second Line	:	SUITE 221
City	:	GLENDALE
State	:	CA
Zip	:	91204-2530
Country	:	US
Telephone Number	:	818-242-0475
Fax Number	:	818-662-0260

Provider Business Practice Location Address
First Line	:	1500 S CENTRAL AVE
Second Line	:	SUITE 221
City	:	GLENDALE
State	:	CA
Zip	:	91204-2530
Country	:	US
Telephone Number	:	818-242-0475
Fax Number	:	818-662-0260

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	03/24/2022

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Directions to “ CHRISTINE AYVAZYAN PA” Practice Location

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