DR. KETEVAN GENDZEKHADZE


Address: 1500 Duarte Rd, Duarte, CA 91010-3012
Phone: 6262568621

DR. KETEVAN GENDZEKHADZE (NPI# 1265700660) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1265700660
Entity Type Individual
Full Name DR. KETEVAN GENDZEKHADZE
Credential PHD
Practice Address 1500 Duarte Rd
Duarte
CA 91010-3012
Mailing Address 1817 2nd St Apt 26
Duarte
CA 91010-1822
Practice Telephone 6262568621
Mailing Telephone 6262517030
Enumeration Date 2011-12-13
Last Update Date 2011-12-13
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 247ZC0005X Pathology
Specialization: Clinical Laboratory Director, Non-physician
DRK38 CA Technologists, Technicians & Other Technical Service Providers

Office Location

Street Address 1500 DUARTE RD
City DUARTE
State CA
Zip Code 91010-3012

Providers in the same location

NPI Name Taxonomy Address Enumeration
1861498271 Marwan G Fakih Internal Medicine 1500 Duarte Rd, Duarte, CA 91010-3012 2005-06-22
1801403688 Jia-chi Wang Medical Genetics 1500 Duarte Rd, Duarte, CA 91010-3012 2020-09-25
1053923300 Ying Moua Social Worker 1500 Duarte Rd, Duarte, CA 91010-3000 2020-08-18
1477163814 Elise Sobotka Genetic Counselor, MS 1500 Duarte Rd, Duarte, CA 91010-3012 2020-07-31
1033728217 Gabriela Claudia Medrano Nurse Practitioner 1500 Duarte Rd, Duarte, CA 91010-3012 2020-07-23
1538783295 Lynn Kim Occupational Therapist 1500 Duarte Rd, Duarte, CA 91010-3012 2020-05-29
1235759887 Jessica Vuong Pharmacist 1500 Duarte Rd, Duarte, CA 91010-3012 2020-04-23
1073133104 Edward Thanasombat Pharmacist 1500 Duarte Rd, Duarte, CA 91010-3012 2020-04-18
1285254300 Tu Nguyen Doan Vuong Pharmacist 1500 Duarte Rd, Duarte, CA 91010-3012 2020-04-18
1093344756 Amy Marie Mcgovern Nurse Practitioner 1500 Duarte Rd, Duarte, CA 91010-3012 2020-04-05
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1386266849 Cheyenne King Student in an Organized Health Care Education/Training Program 1801 Huntington Drive, Duarte, Ca 91010, Duarte, CA 91010 2020-05-07
1114578028 Cristian Gonzalez Case Manager/Care Coordinator 2250 E Foothill Ave, Pasadena, CA 91010 2019-09-23
1366932378 Maisie Madrid Marriage & Family Therapist 1801 Huntington Drive, Duarte, CA 91010 2018-05-15
1598289571 Bertha Maria Torres Social Worker 938 E. Huntington Drive, Unit A, Duarte, CA 91010 2017-08-01
1598292286 Sheila Ramirez Occupational Therapy Assistant 2302 Citrus View Ave, Duarte, CA 91010 2017-05-12
1982059556 Patricia Mendoza Case Manager/Care Coordinator 2502 E.huntington Dr., Duarte, CA 91010 2016-05-02
1770966178 Sinziana Dumitra Surgery 1500 Durate Road California, Mob L001, Duarte, CA 91010 2015-07-02
1477940161 Jin Sun L Bitar Internal Medicine 1500 Duarte Rd # Wing4, Duarte, CA 91010 2015-04-20
1659625622 Jeanette Marie Petermann Nurse Practitioner 1036 East Huntington Drive, Duarte, CA 91010 2012-10-30
1649534397 Nathaniel J Khoe Dds. Inc Dentist 1016 Huntington Drive, Duarte, CA 91010 2012-06-27
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Taxonomy Information

Taxonomy Code 247ZC0005X
Grouping Technologists, Technicians & Other Technical Service Providers
Classification Pathology
Specialization Clinical Laboratory Director, Non-physician

Taxonomy Definition

An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405.
Notes: Source: National Uniform Claim Committee [1/1/2007: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1790970648 Bernard Richard Tegtmeier Pathology 1500 Duarte Rd, Duarte, CA 91010-3012 2007-09-12
1528277654 Marilyn Louise Slovak Pathology 1500 Duarte Rd, Northwest Building, Room 2255, Duarte, CA 91010-3012 2007-05-22

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1851915888 Pangea Laboratory LLC Pathology 3189 Red Hill Ave Ste D, Costa Mesa, CA 92626-3426 2020-06-05
1851913354 The Laab LLC Pathology 664b W Broadway, Glendale, CA 91204-1008 2020-05-07
1811492028 Andy Madoyan Pathology 1737 E Washington Blvd Ste 5, Pasadena, CA 91104-2772 2018-03-28
1972045110 Anthony Butch Pathology 2122 Granville Ave, Los Angeles, CA 90095-6106 2016-11-04
1730589102 Dale Ann Schwab Pathology 5785 Corporate Ave, Cypress, CA 90630-4726 2014-09-03
1992366843 Tharanga Niroshini Senaratne Pathology 10833 Le Conte Ave, Los Angeles, CA 90095-3075 2019-06-21
1205494218 Jack Ji Pathology 180 Kimball Way, South San Francisco, CA 94080-6218 2019-06-04
1831753839 Daniel Yue-king Chan Pathology 430 S Cataract Ave, San Dimas, CA 91773-2902 2019-04-24
1811295165 Athena M Cherry Pathology 3375 Hillview Ave, Room 2809, Palo Alto, CA 94304-1204 2011-03-10
1386962884 Gordana Raca Pathology 4650 W Sunset Blvd, Los Angeles, CA 90027-6062 2010-05-07
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Competitor

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City DUARTE
Zip Code 91010

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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