Healthcare Provider Details

I. General information

NPI: 1073389110
Provider Name (Legal Business Name): ANAIS JACQUELINE HACOBIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S BEAUDRY AVE
LOS ANGELES CA
90012-2014
US

IV. Provider business mailing address

1843 AYERS WAY
BURBANK CA
91501-1106
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: