Healthcare Provider Details

I. General information

NPI: 1245390566
Provider Name (Legal Business Name): ELIZA KHANJIAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BRAND BLVD STE 220
GLENDALE CA
91203-2642
US

IV. Provider business mailing address

PO BOX 250
LA CANADA FLINTRIDGE CA
91012-0250
US

V. Phone/Fax

Practice location:
  • Phone: 818-396-5343
  • Fax: 818-561-3997
Mailing address:
  • Phone: 818-396-5343
  • Fax: 818-561-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY19586
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: