Healthcare Provider Details

I. General information

NPI: 1992522098
Provider Name (Legal Business Name): ELIZA HOVHANNISYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2024
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 W EMPIRE AVE
BURBANK CA
91504-3212
US

IV. Provider business mailing address

1714 IVAR AVE APT 612
LOS ANGELES CA
90028-5138
US

V. Phone/Fax

Practice location:
  • Phone: 818-634-1163
  • Fax:
Mailing address:
  • Phone: 818-636-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: