Healthcare Provider Details

I. General information

NPI: 1801968169
Provider Name (Legal Business Name): ANNA MEKIKYAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2048 MONTROSE AVE
MONTROSE CA
91020-1605
US

IV. Provider business mailing address

2048 MONTROSE AVE
MONTROSE CA
91020-1605
US

V. Phone/Fax

Practice location:
  • Phone: 818-957-2224
  • Fax: 818-957-2261
Mailing address:
  • Phone: 818-244-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA92834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: