Provider Demographics
NPI:1699906727
Name:STEPHANIAN, LIYA MANUKYAN (PA)
Entity type:Individual
Prefix:
First Name:LIYA
Middle Name:MANUKYAN
Last Name:STEPHANIAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LIYA
Other - Middle Name:
Other - Last Name:MANUKYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:635 ANDERSON ROAD
Practice Address - Street 2:SUITE 10
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3505
Practice Address - Country:US
Practice Address - Phone:530-758-1122
Practice Address - Fax:530-758-1646
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20438363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical