Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 84781 | GA |
N | 208800000X | Urologist | A160611 | CA |
NPI | 1033552799 |
---|---|
Provider Name | Andrew Pridjian |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Atlanta, GA 30342-1776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2013 |
Last Update Date | 12/05/2020 |