Provider Demographics
NPI:1619927696
Name:KOUPALIAN, ARAKSYA ROXY (PA)
Entity Type:Individual
Prefix:
First Name:ARAKSYA
Middle Name:ROXY
Last Name:KOUPALIAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 VERDUGO BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1408
Mailing Address - Country:US
Mailing Address - Phone:818-790-1088
Mailing Address - Fax:818-790-1778
Practice Address - Street 1:1818 VERDUGO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1408
Practice Address - Country:US
Practice Address - Phone:818-790-1088
Practice Address - Fax:818-790-1778
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17692363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB6533245OtherCA DRIVER LICENSE