Healthcare Provider Details

I. General information

NPI: 1770431306
Provider Name (Legal Business Name): BRIAN EZEQUIEL SCHIAVONE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16750 SHERMAN WAY APT 213
VAN NUYS CA
91406-3745
US

IV. Provider business mailing address

16750 SHERMAN WAY APT 213
VAN NUYS CA
91406-3745
US

V. Phone/Fax

Practice location:
  • Phone: 424-672-0777
  • Fax:
Mailing address:
  • Phone: 424-672-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95037661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: