Individual
ANDRE BASMADZHYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
732 MOTT ST STE 100-110, SAN FERNANDO, CA 91340-4237
(818) 963-5690
Mailing address
732 MOTT ST STE 100-110, SAN FERNANDO, CA 91340-4237
(818) 963-5690
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A18560
CA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/20/2017
Last updated
11/05/2020
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