Healthcare Provider Details

I. General information

NPI: 1447938972
Provider Name (Legal Business Name): RENYA BAZIKIAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 SAN VICENTE BLVD STE 103
LOS ANGELES CA
90019-6667
US

IV. Provider business mailing address

124 W CHEVY CHASE DR
GLENDALE CA
91204-2316
US

V. Phone/Fax

Practice location:
  • Phone: 310-295-9571
  • Fax:
Mailing address:
  • Phone: 818-397-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: