Provider Demographics
NPI:1699307645
Name:SEXENIAN, NATALIE NVART (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:NVART
Last Name:SEXENIAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 TAMPA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1713
Mailing Address - Country:US
Mailing Address - Phone:818-718-1600
Mailing Address - Fax:
Practice Address - Street 1:7640 TAMPA AVE STE 101
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1713
Practice Address - Country:US
Practice Address - Phone:818-718-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57775363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical