Basic Information
| Provider Information | |||||||||
| NPI: | 1629272307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORAVIAN | ||||||||
| FirstName: | FREDERICK | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1142 CAMPBELL ST | ||||||||
| Address2: | 310 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912071643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185000344 | ||||||||
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| Practice Location | |||||||||
| Address1: | 191 S BUENA VISTA ST | ||||||||
| Address2: | SUITE 235 | ||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915054554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182955910 | ||||||||
| FaxNumber: | 8185242807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA16857 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.