Healthcare Provider Details

I. General information

NPI: 1922347731
Provider Name (Legal Business Name): SANAN ALEXANDARIAN M.SC., CCC-SLP#21273
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE L-02
PASADENA CA
91106-2401
US

IV. Provider business mailing address

506 W SIERRA MADRE BLVD APT A
SIERRA MADRE CA
91024-2370
US

V. Phone/Fax

Practice location:
  • Phone: 626-677-7939
  • Fax:
Mailing address:
  • Phone: 818-640-4883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: