Provider Demographics
NPI:1174390306
Name:AREVYAN, SUZY
Entity type:Individual
Prefix:
First Name:SUZY
Middle Name:
Last Name:AREVYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9675 BRIGHTON WAY STE 340
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5155
Mailing Address - Country:US
Mailing Address - Phone:310-203-0511
Mailing Address - Fax:
Practice Address - Street 1:6461 TEESDALE AVE
Practice Address - Street 2:
Practice Address - City:VALLEY GLEN
Practice Address - State:CA
Practice Address - Zip Code:91606-1246
Practice Address - Country:US
Practice Address - Phone:818-688-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant