Individual
DR. HERMOZ B AYVAZIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
110 S ADAMS ST, GLENDALE, CA 91205-1312
(818) 242-4426
(818) 242-4409
Mailing address
110 S ADAMS ST, GLENDALE, CA 91205-1312
(818) 242-4426
(818) 242-4409
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E3761
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E37610
—
CA
01
—
05D0856782
CLIA
CA
01
—
200858800
US DEPT OF LABOR
CA
01
—
4320950001
DMERC ID
CA
01
—
480027586
RAILROAD MEDICARE
CA
01
—
954745477
TAX ID
CA
01
—
E3761
BLUE CROSS
CA
01
—
ZZZ60226Z
BLUE SHIELD
CA
Enumeration date
10/20/2006
Last updated
12/11/2018
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