MEDICARE: DR. ADELINA VORPERIAN MD

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	207R00000X	Internal Medicine Physician	C50390	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C50390	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1699722306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADELINA VORPERIAN MD

Provider Business Mailing Address
First Line	:	1215 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2503
Country	:	US
Telephone Number	:	818-553-0800
Fax Number	:	818-553-0804

Provider Business Practice Location Address
First Line	:	6501 FOOTHILL BLVD
Second Line	:	#101
City	:	TUJUNGA
State	:	CA
Zip	:	91042-2765
Country	:	US
Telephone Number	:	818-352-2111
Fax Number	:	818-352-5740

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	01/05/2010

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