Healthcare Provider Details

I. General information

NPI: 1932450954
Provider Name (Legal Business Name): MARAT SHPOLYANSKY N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S VICTORY BLVD STE 206
BURBANK CA
91502-2793
US

IV. Provider business mailing address

13920 EMELITA ST
VAN NUYS CA
91401-4339
US

V. Phone/Fax

Practice location:
  • Phone: 747-271-2701
  • Fax: 310-693-5384
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number806846
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95000350
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95000350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: