Individual provider Active NPI

Lida Avetisyan, MD

  • Internal Medicine Physician
  • Fresno, CA
National Provider Identifier
1487334553
Registry record updated Jul 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A209872 Issued in CA
Practice address
1221 E Spruce Ave
Fresno, CA 93720-3374
Phone
(559) 450-5777
Fax
(559) 450-5687
NPI assigned
Jul 24, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A209872 CA Primary

Addresses

Primary practice location

1221 E Spruce Ave
Fresno, CA 93720-3374

Mailing address

1111 E Spruce Ave Ste 431
Fresno, CA 93720-3330
Phone (559) 450-7449

Other practice location 1

234 E 149th St
Bronx, NY 10451-5504
Phone (718) 579-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783296000000",
    "number": "1487334553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 E SPRUCE AVE STE 431",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203330",
            "telephone_number": "559-450-7449",
            "fax_number": "559-450-7472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 E SPRUCE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203374",
            "telephone_number": "559-450-5777",
            "fax_number": "559-450-5687"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "234 E 149th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104515504",
            "country_code": "US",
            "telephone_number": "718-579-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AVETISYAN",
        "first_name": "LIDA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-24",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A209872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.