Provider Demographics
NPI:1558198507
Name:SEPETJIAN, TALAR
Entity type:Individual
Prefix:
First Name:TALAR
Middle Name:
Last Name:SEPETJIAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 FOOTHILL BLVD # 1492
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3402
Mailing Address - Country:US
Mailing Address - Phone:818-418-9790
Mailing Address - Fax:
Practice Address - Street 1:99 ALMADEN BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1605
Practice Address - Country:US
Practice Address - Phone:818-418-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2024064575363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health