Provider Demographics
NPI:1174730576
Name:MADOYAN, VAZGEN ARAM SR (LAC,)
Entity type:Individual
Prefix:MR
First Name:VAZGEN
Middle Name:ARAM
Last Name:MADOYAN
Suffix:SR
Gender:M
Credentials:LAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S MENTOR AVE
Mailing Address - Street 2:300
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2927
Mailing Address - Country:US
Mailing Address - Phone:626-564-8798
Mailing Address - Fax:
Practice Address - Street 1:34 S MENTOR AVE
Practice Address - Street 2:300
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2927
Practice Address - Country:US
Practice Address - Phone:626-564-8798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10726171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist