| Axiograft | |
|
815 S Central Ave Ste 11 Glendale CA 91204-2080 | |
| (818) 325-5090 | |
| Not Available |
| Full Name | Axiograft |
|---|---|
| Speciality | Internal Medicine |
| Location | 815 S Central Ave Ste 11, Glendale, California |
| Authorized Official Name and Position | Manvel Kondradzhyan (CEO) |
| Authorized Official Contact | 3232535821 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Axiograft 815 S Central Ave Ste 11 Glendale CA 91204-2080 Ph: (818) 325-5090 | Axiograft 815 S Central Ave Ste 11 Glendale CA 91204-2080 Ph: (818) 325-5090 |
| NPI Number | 1750264677 |
|---|---|
| Provider Enumeration Date | 07/29/2025 |
| Last Update Date | 07/29/2025 |
| Certification Date | 07/28/2025 |
| Medicare PECOS PAC ID | 9234633868 |
|---|---|
| Medicare Enrollment ID | O20250917002797 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750264677 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Manvel Kondradzhyan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568988590 PECOS PAC ID: 4082975941 Enrollment ID: I20180311000001 |
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