Active NPI
Tamara Matevosyan, D.D.S.
- Dentist
- Marina del Rey, CA
National Provider Identifier
1215325857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 63008
- Practice address
- 3206 Washington Blvd
Marina del Rey, CA 90292-5553 - Phone
- (310) 827-6453
- NPI assigned
- Jan 6, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 63008 | CA | Primary |
Addresses
Primary practice location
3206 Washington Blvd
Marina del Rey, CA 90292-5553
Mailing address
3048 Fairesta St
La Crescenta, CA 91214
Phone (818) 720-4160
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421020800000",
"number": "1215325857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3048 FAIRESTA ST",
"city": "LA CRESCENTA",
"state": "CA",
"postal_code": "91214",
"telephone_number": "818-720-4160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3206 WASHINGTON BLVD",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "902925553",
"telephone_number": "310-827-6453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATEVOSYAN",
"first_name": "TAMARA",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-06",
"last_updated": "2015-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "63008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marina del Rey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.