Individual
BEN DJABOURIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
143 E. ROWLAND ST. SUITE 2, COVINA, CA 91723-3000
(626) 858-9460
(626) 858-9767
Mailing address
153 E ROWLAND ST, COVINA, CA 91723-3049
(626) 858-9460
(626) 858-9767
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
Primary
—
—
224P00000X
Prosthetist
—
—
225000000X
Orthotic Fitter
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
0306
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4974734
MEDICAID PIN
CA
05
—
DME03036F
—
CA
Enumeration date
02/14/2008
Last updated
07/24/2024
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