Core Geriatric Medical Group LLC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Legal business name

CORE GERIATRIC MEDICAL GROUP LLC

Practice address

1505 S Glendale Ave
Glendale, CA 91205-3315

Phone

(818) 758-9588

Fax

(818) 975-5217

NPI assigned

Apr 25, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christine Ayvazyan, MSPA-C

Title

Owner

Phone

(818) 723-8804

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524614400000",
    "number": "1417445487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 S GLENDALE AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912053315",
            "telephone_number": "818-758-9588",
            "fax_number": "818-975-5217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 S GLENDALE AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912053315",
            "telephone_number": "818-758-9588",
            "fax_number": "818-975-5217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORE GERIATRIC MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-25",
        "last_updated": "2018-04-25",
        "status": "A",
        "authorized_official_last_name": "AYVAZYAN",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-723-8804",
        "authorized_official_credential": "MSPA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Glendale, CA
• Providers in Glendale, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.