Healthcare Provider Details

I. General information

NPI: 1114868296
Provider Name (Legal Business Name): ANNIE KAZAROVA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E OLIVE AVE STE 750
BURBANK CA
91501-2132
US

IV. Provider business mailing address

10025 SULLY DR
SUN VALLEY CA
91352-4270
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-4114
  • Fax:
Mailing address:
  • Phone: 323-369-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: