Provider Demographics
NPI:1538625405
Name:AVETISYAN, ARMEN (PA-C)
Entity type:Individual
Prefix:
First Name:ARMEN
Middle Name:
Last Name:AVETISYAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N BELMONT ST UNIT 309
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3899
Mailing Address - Country:US
Mailing Address - Phone:818-800-8010
Mailing Address - Fax:
Practice Address - Street 1:1245 WILSHIRE BLVD STE 606
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4806
Practice Address - Country:US
Practice Address - Phone:213-483-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56686363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical