Healthcare Provider Details

I. General information

NPI: 1578296554
Provider Name (Legal Business Name): AJMIN SARIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

746 S LOS ANGELES ST APT 602
LOS ANGELES CA
90014-2183
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-6049
  • Fax: 818-847-4842
Mailing address:
  • Phone: 818-331-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021302
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95021302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: