Provider Demographics
NPI:1720371099
Name:STEPANIAN, CARLEN CARL (BUSINESS)
Entity Type:Individual
Prefix:
First Name:CARLEN
Middle Name:CARL
Last Name:STEPANIAN
Suffix:
Gender:M
Credentials:BUSINESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10523 BURBANK BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2236
Mailing Address - Country:US
Mailing Address - Phone:818-859-7659
Mailing Address - Fax:818-859-7659
Practice Address - Street 1:10523 BURBANK BLVD STE 115
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2236
Practice Address - Country:US
Practice Address - Phone:818-859-7659
Practice Address - Fax:818-859-7659
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3330032163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice