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General NPI Number Information
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NPI Number | 1104228097
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Entity Type | Individual
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Provider Name | OLGA VARDANYAN C.N.S., M.D., PH.D
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Gender | Female
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 333 E MAGNOLIA BLVD SUITE 102
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City | BURBANK
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State | CA
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Zip | 91502-1153
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Country | US
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Telephone | 818-729-0300
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Fax | 818-729-0400
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Provider Business Mailing Address
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Address Line | 333 E MAGNOLIA BLVD SUITE 102
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City | BURBANK
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State | CA
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Zip | 91502-1153
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Country | US
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Telephone | 818-729-0300
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Fax | 818-729-0400
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | CNS16161
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License Number State | CA
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