MEDICARE: SHANNON VARTANIAN

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1245199660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON VARTANIAN

Provider Business Mailing Address
First Line	:	1081 N TUSTIN AVE STE 115
Second Line	:	PMB 1002
City	:	ANAHEIM
State	:	CA
Zip	:	92807-1737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 N TUSTIN AVE STE 115
Second Line	:	PMB 1002
City	:	ANAHEIM
State	:	CA
Zip	:	92807-1737
Country	:	US
Telephone Number	:	323-284-7998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/23/2026

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Directions to “ SHANNON VARTANIAN ” Practice Location

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