Healthcare Provider Details

I. General information

NPI: 1134638539
Provider Name (Legal Business Name): ARTUR VARDANYAN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20644 SAN JOSE ST
CHATSWORTH CA
91311-2458
US

IV. Provider business mailing address

20644 SAN JOSE ST
CHATSWORTH CA
91311-2458
US

V. Phone/Fax

Practice location:
  • Phone: 818-653-0782
  • Fax:
Mailing address:
  • Phone: 818-653-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000037984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: