Healthcare Provider Details

I. General information

NPI: 1750035200
Provider Name (Legal Business Name): ALEX SEFIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S GLENDALE AVE
GLENDALE CA
91205-3203
US

IV. Provider business mailing address

1112 S GLENDALE AVE
GLENDALE CA
91205-3203
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-0800
  • Fax:
Mailing address:
  • Phone: 818-500-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: