Individual
JASON DERHOVANESIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4441 E KINGS CANYON RD, FRESNO, CA 93702-3604
(559) 600-9180
Mailing address
155 N FRESNO ST, FRESNO, CA 93701-2302
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
20A20288
CA
2084P0800X
Psychiatry Physician
PTL1076
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2019
Last updated
05/18/2023
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