Healthcare Provider Details

I. General information

NPI: 1811261266
Provider Name (Legal Business Name): ANAHIT HOVHANNISYAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CENTRAL AVE 321
GLENDALE CA
91204-2530
US

IV. Provider business mailing address

1500 S CENTRAL AVE 321
GLENDALE CA
91204-2530
US

V. Phone/Fax

Practice location:
  • Phone: 818-620-4040
  • Fax: 818-409-0007
Mailing address:
  • Phone: 818-620-4040
  • Fax: 818-409-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: