Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 261242 | MA |
Y | 207K00000X | Allergist & Immunologist | A85631 | CA |
N | 207R00000X | Internist | A85631 | CA |
N | 111NI0900X | Internist | A85631 | CA |
NPI | 1184772048 |
---|---|
Provider Name | Flora Abrahamian Vardanian |
First Address | Pasadena, CA 91101-1740 |
Second Address | Pasadena, CA 91101-1740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 12/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A856310 | (05) | CA |
I49579 | (02) |