Basic Information
| Provider Information | |||||||||
| NPI: | 1003386558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEPANYAN | ||||||||
| FirstName: | NARE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 609 ST PAUL AVE # APP515 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900176006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546753257 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 S CHEVY CHASE DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912054436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185005586 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2018 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A158879 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A158879 | 01 | CA | MEDICAL LICENCE | OTHER |