Andre Basmadzhyan, D.O.
Family Medicine in San Fernando, CA. Individual provider (NPI-1).
NPI number1508307745
StatusActive
Last updated in NPPESNov 5, 2020
Details
- NPI
- 1508307745
- Entity type
- Individual (NPI-1)
- Name
- Andre Basmadzhyan
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 20, 2017
- Certification date
- Nov 5, 2020
- Last updated
- Nov 5, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 20A18560 | CA | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
732 Mott St Ste 100-110San Fernando, CA 91340-4237
Phone 818-963-5690
Mailing address
732 Mott St Ste 100-110San Fernando, CA 91340-4237
Phone 818-963-5690
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