Healthcare Provider Details

I. General information

NPI: 1003674664
Provider Name (Legal Business Name): ANASHEH AVANES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W OLIVE AVE
BURBANK CA
91506-2214
US

IV. Provider business mailing address

7816 STANSBURY AVE
PANORAMA CITY CA
91402-5215
US

V. Phone/Fax

Practice location:
  • Phone: 747-477-1411
  • Fax:
Mailing address:
  • Phone: 818-823-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: