Healthcare Provider Details

I. General information

NPI: 1679703847
Provider Name (Legal Business Name): ANNA GHAZANCHYAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR # 60
GLENDALE CA
91205-4431
US

IV. Provider business mailing address

801 S CHEVY CHASE DR # 60
GLENDALE CA
91205-4431
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-7744
  • Fax: 818-240-7755
Mailing address:
  • Phone: 818-240-7744
  • Fax: 818-240-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANNA GHAZANCHYAN
Title or Position: OWNER
Credential: RDCS, RVT
Phone: 818-240-7744