Provider Demographics
NPI:1053104364
Name:ANI OVSEPIAN, PHYSICIAN ASSISTANT, PC
Entity type:Organization
Organization Name:ANI OVSEPIAN, PHYSICIAN ASSISTANT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANI
Authorized Official - Middle Name:
Authorized Official - Last Name:OVSEPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:818-370-8091
Mailing Address - Street 1:PO BOX 9131
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91226-0131
Mailing Address - Country:US
Mailing Address - Phone:818-369-9807
Mailing Address - Fax:
Practice Address - Street 1:16661 VENTURA BLVD STE 313
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1956
Practice Address - Country:US
Practice Address - Phone:818-369-9807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty