Healthcare Provider Details

I. General information

NPI: 1194240804
Provider Name (Legal Business Name): ANNA SARDARIYANST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E ROUTE 66
GLENDORA CA
91740-3501
US

IV. Provider business mailing address

1200 S BRAND BLVD # 434
GLENDALE CA
91204-2641
US

V. Phone/Fax

Practice location:
  • Phone: 626-466-2831
  • Fax:
Mailing address:
  • Phone: 818-383-6042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: