MEDICARE: ALEXANDER S GUREGHIAN PA-C

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	363A00000X	Physician Assistant	1167087

General Provider Information

NPI Number	:	1932715059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER S GUREGHIAN PA-C

Provider Business Mailing Address
First Line	:	6595 PROVENCE RD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-1741
Country	:	US
Telephone Number	:	626-215-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	6595 PROVENCE RD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-1741
Country	:	US
Telephone Number	:	626-215-5511
Fax Number	:

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

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	09/23/2020

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