Provider Demographics
NPI:1629272307
Name:NORAVIAN, FREDERICK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:NORAVIAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 CAMPBELL ST
Mailing Address - Street 2:310
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1643
Mailing Address - Country:US
Mailing Address - Phone:818-500-0344
Mailing Address - Fax:
Practice Address - Street 1:191 S BUENA VISTA ST
Practice Address - Street 2:SUITE 235
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4554
Practice Address - Country:US
Practice Address - Phone:818-295-5910
Practice Address - Fax:818-524-2807
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16857363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN731XMedicare PIN
CAAN731WMedicare PIN
CAAN731VMedicare PIN