Provider Demographics
NPI:1043526395
Name:ADJIAN, NATALIYA (RPT)
Entity Type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:ADJIAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18946 GRANADA CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:631 E COLORADO BLVD
Practice Address - Street 2:SUITE # C
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1797
Practice Address - Country:US
Practice Address - Phone:818-507-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT19168AMedicaid