Healthcare Provider Details

I. General information

NPI: 1629272307
Provider Name (Legal Business Name): FREDERICK NORAVIAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 02/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST SUITE 235
BURBANK CA
91505-4554
US

IV. Provider business mailing address

1142 CAMPBELL ST 310
GLENDALE CA
91207-1643
US

V. Phone/Fax

Practice location:
  • Phone: 818-295-5910
  • Fax: 818-524-2807
Mailing address:
  • Phone: 818-500-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: