Provider Demographics
NPI:1154518041
Name:KAZARIANS, ALICIA VANEE (NP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:VANEE
Last Name:KAZARIANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 E DEL MAR BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4649
Mailing Address - Country:US
Mailing Address - Phone:626-270-2400
Mailing Address - Fax:626-270-2496
Practice Address - Street 1:3160 E DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4649
Practice Address - Country:US
Practice Address - Phone:626-270-2400
Practice Address - Fax:626-270-2496
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601856363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154518041Medicaid
CA13161113145Medicaid
CANP17521OtherNP LIC
CANP17521OtherNP LIC
CA13161113145Medicaid