Provider Demographics
NPI:1538912464
Name:TEVOSYAN, NAIRA
Entity type:Individual
Prefix:
First Name:NAIRA
Middle Name:
Last Name:TEVOSYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 1/2 N NORMANDIE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5109
Mailing Address - Country:US
Mailing Address - Phone:323-707-2055
Mailing Address - Fax:
Practice Address - Street 1:1657 1/2 N NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5109
Practice Address - Country:US
Practice Address - Phone:323-707-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle