Healthcare Provider Details

I. General information

NPI: 1972439511
Provider Name (Legal Business Name): ASA WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6449 RADFORD AVE
NORTH HOLLYWOOD CA
91606-2813
US

IV. Provider business mailing address

6449 RADFORD AVE
NORTH HOLLYWOOD CA
91606-2813
US

V. Phone/Fax

Practice location:
  • Phone: 818-464-6112
  • Fax:
Mailing address:
  • Phone: 818-464-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ANDRE SHAHBAZYAN
Title or Position: CEO
Credential:
Phone: 818-464-6112