MEDICARE: CAROLYN GHAZARIAN PA

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		CA

General Provider Information

NPI Number	:	1568353266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN GHAZARIAN PA

Provider Business Mailing Address
First Line	:	8241 BELLINGHAM AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1308
Country	:	US
Telephone Number	:	818-391-6311
Fax Number	:

Provider Business Practice Location Address
First Line	:	8241 BELLINGHAM AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-1308
Country	:	US
Telephone Number	:	818-391-6311
Fax Number	:

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

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	07/10/2025

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