MEDICARE: STEPANYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	390200000X	OTHER	CA	STUDENT IN AN ORGANIZED HEALTH CARE EDUCATION/TRAINING PROGRAM

General Provider Information

NPI Number	:	1053857649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPANYAN

Provider Business Mailing Address
First Line	:	801 S CHEVY CHASE DR STE 201
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-4435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 S CHEVY CHASE DR STE 201
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-4435
Country	:	US
Telephone Number	:	954-675-3257
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	NARE STEPANYAN
Credential	:
Telephone Number	:	954-675-3257

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	01/06/2017

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Directions to “STEPANYAN ” Practice Location

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