MEDICARE: ANAHID ASSATOURIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY 25896	CA

General Provider Information

NPI Number	:	1154744415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAHID ASSATOURIAN

Provider Business Mailing Address
First Line	:	3520 STANCREST DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1322
Country	:	US
Telephone Number	:	818-248-2059
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 STANCREST DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1322
Country	:	US
Telephone Number	:	818-248-2059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	01/22/2014

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