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General NPI Number Information
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NPI Number | 1932450954
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Entity Type | Individual
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Provider Name | MARAT SHPOLYANSKY N.P.
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Gender | Male
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1201 S VICTORY BLVD STE 206
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City | BURBANK
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State | CA
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Zip | 91502-2793
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Country | US
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Telephone | 747-271-2701
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Fax | 310-693-5384
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Provider Business Mailing Address
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Address Line | 13920 EMELITA ST
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City | VAN NUYS
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State | CA
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Zip | 91401-4339
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 806846
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 95000350
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95000350
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License Number State | CA
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