Provider Demographics
NPI:1376392647
Name:NOVSHADYAN, ARLENA
Entity type:Individual
Prefix:
First Name:ARLENA
Middle Name:
Last Name:NOVSHADYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 E ANGELENO AVE APT A
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2232
Mailing Address - Country:US
Mailing Address - Phone:818-414-9534
Mailing Address - Fax:
Practice Address - Street 1:200 S ROBLES AVE
Practice Address - Street 2:
Practice Address - City:PASADNEA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-817-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032093363LP2300X
CA95263176163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse