MEDICARE: MARTIN AIRIAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	51964	CA

General Provider Information

NPI Number	:	1558737791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN AIRIAN PA-C

Provider Business Mailing Address
First Line	:	516 NARANJA DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-3445
Country	:	US
Telephone Number	:	213-999-6736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1577 E CHEVY CHASE DR STE 240
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4742
Country	:	US
Telephone Number	:	818-937-9551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	07/21/2022

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Directions to “ MARTIN AIRIAN PA-C” Practice Location

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