Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 53494 | AZ |
N | 2081P2900X | Pain Medicine | 53494 | AZ |
N | 2081S0010X | Sports Medicine | ME124991 | FL |
N | 213ES0000X | Sports Medicine | ME124991 | FL |
N | 208D00000X | General Practice Physician | ME24991 | FL |
NPI | 1275978876 |
---|---|
Provider Name | Dr. Armen Derian |
First Address | Mission Hills, CA 91345-2607 |
Second Address | Scottsdale, AZ 85257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2013 |
Last Update Date | 09/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023449000 | (05) | FL |