Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A158879 | CA |
NPI | 1003386558 |
---|---|
Provider Name | Dr. Nare Stepanyan |
First Address | Los Angeles, CA 90017-6006 |
Second Address | Glendale, CA 91205-4436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2018 |
Last Update Date | 27/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A158879 | MEDICAL LICENCE (01) | CA |