Healthcare Provider Details

I. General information

NPI: 1023480373
Provider Name (Legal Business Name): ANI OGANESYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 VIA MARISOL
LOS ANGELES CA
90042-4883
US

IV. Provider business mailing address

713 GROTON DR
BURBANK CA
91504-2422
US

V. Phone/Fax

Practice location:
  • Phone: 818-486-4979
  • Fax:
Mailing address:
  • Phone: 818-486-4979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: