Healthcare Provider Details

I. General information

NPI: 1356519474
Provider Name (Legal Business Name): ARIEL GAN LOO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BUENA VISTA ST SUITE 410
BURBANK CA
91505-4569
US

IV. Provider business mailing address

201 S BUENA VISTA ST SUITE 410
BURBANK CA
91505-4569
US

V. Phone/Fax

Practice location:
  • Phone: 818-562-6400
  • Fax: 818-562-6405
Mailing address:
  • Phone: 818-562-6400
  • Fax: 818-562-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17641
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberNP17641
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: