Healthcare Provider Details

I. General information

NPI: 1912735325
Provider Name (Legal Business Name): AILEEN KASPARIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N PACIFIC AVE STE 103
GLENDALE CA
91202-4312
US

IV. Provider business mailing address

1101 N PACIFIC AVE STE 103
GLENDALE CA
91202-4312
US

V. Phone/Fax

Practice location:
  • Phone: 818-552-5000
  • Fax: 818-956-0990
Mailing address:
  • Phone: 818-552-5000
  • Fax: 818-956-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95031229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: