Individual provider Active NPI

Liya Manukyan Stephanian, PA

  • Medical Physician Assistant
  • Davis, CA
National Provider Identifier
1699906727
Registry record updated Jul 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA20438 Issued in CA
Practice address
635 Anderson Road
Suite 10
Davis, CA 95616-3505
Phone
(530) 758-1122
Fax
(530) 758-1646
NPI assigned
Aug 6, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA20438 CA Primary

Addresses

Primary practice location

635 Anderson Road
Suite 10
Davis, CA 95616-3505

Mailing address

10470 Old Placerville Rd
Suite 100
Sacramento, CA 95827-2539
Phone (800) 470-0071

Other names 1

  • Liya Manukyan Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091205000164 CA Practitioner - Physician Assistant 8729127675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

2800 L St
Sacramento, CA 95816-5616

635 Anderson Rd
Suite 10
Davis, CA 95616-3505
Phone (530) 758-1122

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA20438CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Valley Medical Foundation CurrentSince Mar 6, 2011 Accepting new patients
Sutter Valley Medical Foundation CurrentSince Mar 6, 2011 Accepting new patients

Locations

635 Anderson Rd
Ste 10
Davis, CA 95616
Phone (530) 758-1122

10470 Old Placerville Rd
Ste 100
Sacramento, CA 95827

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

Interoperability endpoints

  • Direct secure messaging: lstephanianpac24411@hisp.ehr.sutterhealth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437955200000",
    "number": "1699906727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD",
            "address_2": "SUITE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 ANDERSON ROAD",
            "address_2": "SUITE 10",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956163505",
            "telephone_number": "530-758-1122",
            "fax_number": "530-758-1646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHANIAN",
        "first_name": "LIYA",
        "middle_name": "MANUKYAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-06",
        "last_updated": "2015-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA20438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LIYA",
            "last_name": "MANUKYAN",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Davis, CA

Sources for this page

Verify at the official NPI Registry.