Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter |
NPI | 1073781886 |
---|---|
Provider Name | Ben Djabourian |
First Address | Covina, CA 91723-3000 |
Second Address | Covina, CA 91723-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 03/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4974734 | MEDICAID PIN (01) | CA |
DME03036F | (05) | CA |