Axoderm Corp

Primary specialty

Medical Toxicology (Emergency Medicine) PhysicianTaxonomy code 207PT0002X

Legal business name

AXODERM CORP

Practice address

1510 S Central Ave Ste 640
Glendale, CA 91204-2552

Phone

(310) 933-5054

Fax

(310) 935-3367

NPI assigned

Sep 3, 2025

Organization subpart

No

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

Authorized official

Name

Angie Davoody

Title

Office Manager / Executive

Phone

(818) 242-3200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sarah Lay

  • Family Nurse Practitioner
  • Cerritos, CA
  • NPI 1225848476
  Medicare reassignment Care Compare group NPD
• Luke Jacob Narciso

  • Family Nurse Practitioner
  • Los Angeles, CA
  • NPI 1528874401
  Medicare reassignment Care Compare group NPD
• David Sherman, M.D.

  • Specialist
  • Glendale, CA
  • NPI 1235164294
  Medicare reassignment Care Compare group NPD
• Bevien Sofia Baroro Monte, FNP

  • Family Nurse Practitioner
  • Northridge, CA
  • NPI 1548951338
  Medicare reassignment NPD

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

{
    "created_epoch": "1756857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756857600000",
    "number": "1891675674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S CENTRAL AVE STE 640",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042552",
            "telephone_number": "310-933-5054",
            "fax_number": "310-935-3367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S CENTRAL AVE STE 640",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042552",
            "telephone_number": "310-933-5054",
            "fax_number": "310-935-3367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXODERM CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-03",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A",
        "authorized_official_last_name": "DAVOODY",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "OFFICE MANAGER / EXECUTIVE",
        "authorized_official_telephone_number": "818-242-3200"
    },
    "taxonomies": [
        {
            "code": "207PT0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Medical Toxicology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emergency Medicine Physician in Glendale, CA
• Providers in Glendale, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.