Provider Demographics
NPI:1902939515
Name:VARTANIANS, TANIA (PAC)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:VARTANIANS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:TATOYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5720
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST STE 3800
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5328
Practice Address - Country:US
Practice Address - Phone:323-442-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18729363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant