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General NPI Number Information
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NPI Number | 1013070929
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Entity Type | Individual
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Provider Name | MARYETTA OVSEPIAN MD PHD
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 04/03/2009
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Provider Practice Location Address
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Address Line | L4445 OLIVE VIEW DRIVE
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City | SYLMAR
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State | CA
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Zip | 91342-1495
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Country | US
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Telephone | 818-364-4350
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Fax | 818-364-4775
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Provider Business Mailing Address
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Address Line | 10125 BROMONT AVE
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City | SUN VALLEY
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State | CA
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Zip | 91352
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Country | US
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Telephone | 818-252-5686
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Fax | 818-252-7187
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A69455
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License Number State | CA
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