Provider Demographics
NPI:1609516343
Name:DAVTYAN, EDVARD (MD, BSRS, RT(R)(F))
Entity type:Individual
Prefix:DR
First Name:EDVARD
Middle Name:
Last Name:DAVTYAN
Suffix:
Gender:M
Credentials:MD, BSRS, RT(R)(F)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4018
Mailing Address - Country:US
Mailing Address - Phone:661-326-2200
Mailing Address - Fax:661-326-2950
Practice Address - Street 1:440 E HUNTINGTON DR STE 200
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3775
Practice Address - Country:US
Practice Address - Phone:626-254-2293
Practice Address - Fax:626-254-8220
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CAA198193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program