Provider Demographics
NPI:1104228097
Name:VARDANYAN, OLGA (CNS, MD, PHD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:VARDANYAN
Suffix:
Gender:F
Credentials:CNS, MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E MAGNOLIA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1153
Mailing Address - Country:US
Mailing Address - Phone:818-729-0300
Mailing Address - Fax:818-729-0400
Practice Address - Street 1:333 E MAGNOLIA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1153
Practice Address - Country:US
Practice Address - Phone:818-729-0300
Practice Address - Fax:818-729-0400
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACNS16161133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist