Provider Demographics
NPI:1669298600
Name:OVSEPIAN, ANI (PA-C)
Entity type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:OVSEPIAN
Suffix:
Gender:F
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:PO BOX 9131
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91226-0131
Mailing Address - Country:US
Mailing Address - Phone:818-369-9807
Mailing Address - Fax:
Practice Address - Street 1:16661 VENTURA BLVD STE 313
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1956
Practice Address - Country:US
Practice Address - Phone:818-369-9807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66014207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine