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General NPI Number Information
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NPI Number | 1083483440
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Entity Type | Individual
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Provider Name | JULIA TARVERDOVA NP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 240 N VIRGIL AVE STE 12
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City | LOS ANGELES
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State | CA
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Zip | 90004-5399
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Country | US
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Telephone | 818-512-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 350 SALEM ST UNIT 202
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City | GLENDALE
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State | CA
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Zip | 91203-2511
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Country | US
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Telephone |
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Fax |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95027603
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License Number State | CA
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