MEDICARE: NATALIE NVART SEXENIAN PHYSICIAN ASSISTANT

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	363AM0700X	Medical Physician Assistant	PA57775	CA

General Provider Information

NPI Number	:	1699307645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE NVART SEXENIAN PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	7640 TAMPA AVE STE 101
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-1713
Country	:	US
Telephone Number	:	818-718-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	7640 TAMPA AVE STE 101
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-1713
Country	:	US
Telephone Number	:	818-718-1600
Fax Number	:

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

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	02/07/2020

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