MEDICARE: ANGELIA ARDALAN PA-C

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	55717	CA

General Provider Information

NPI Number	:	1972087906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIA ARDALAN PA-C

Provider Business Mailing Address
First Line	:	3831 HUGHES AVE STE 601
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-6844
Country	:	US
Telephone Number	:	310-204-0223
Fax Number	:	310-425-8091

Provider Business Practice Location Address
First Line	:	3831 HUGHES AVE STE 601
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-6844
Country	:	US
Telephone Number	:	310-204-0223
Fax Number	:

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

Provider Enumeration Date	:	09/15/2018
Last Update Date	:	11/14/2025

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Directions to “ ANGELIA ARDALAN PA-C” Practice Location

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