Basic Information
| Provider Information | |||||||||
| NPI: | 1457458796 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YEREVANIAN | ||||||||
| FirstName: | BOGHOS | ||||||||
| MiddleName: | I. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23300 PARK HACIENDA | ||||||||
| Address2: | |||||||||
| City: | CALABASAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913021715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184105398 | ||||||||
| FaxNumber: | 8182239277 | ||||||||
| Practice Location | |||||||||
| Address1: | 16111 PLUMMER (116A) | ||||||||
| Address2: | PSYCHIATRY DEPARTMENT BLDG 10 | ||||||||
| City: | NORTH HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188917711 | ||||||||
| FaxNumber: | 8182239277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | C40853 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.