Healthcare Provider Details

I. General information

NPI: 1699722306
Provider Name (Legal Business Name): ADELINA VORPERIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 FOOTHILL BLVD #101
TUJUNGA CA
91042-2765
US

IV. Provider business mailing address

1215 S CENTRAL AVE
GLENDALE CA
91204-2503
US

V. Phone/Fax

Practice location:
  • Phone: 818-352-2111
  • Fax: 818-352-5740
Mailing address:
  • Phone: 818-553-0800
  • Fax: 818-553-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC50390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: