Provider Demographics
NPI:1679534374
Name:NERCESSIAN, ARMEN YEGHIA (DO)
Entity type:Individual
Prefix:DR
First Name:ARMEN
Middle Name:YEGHIA
Last Name:NERCESSIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 S AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1536
Mailing Address - Country:US
Mailing Address - Phone:626-839-9111
Mailing Address - Fax:626-964-9191
Practice Address - Street 1:2425 S AZUSA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1536
Practice Address - Country:US
Practice Address - Phone:626-839-9111
Practice Address - Fax:626-964-9191
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6784208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX67840Medicaid
CA00AX67840Medicaid
CAG25798Medicare UPIN