Healthcare Provider Details

I. General information

NPI: 1164336475
Provider Name (Legal Business Name): ANNA KRISTINE SHAKHIDZHANYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11065 AMIGO AVE
PORTER RANCH CA
91326-2401
US

IV. Provider business mailing address

11065 AMIGO AVE
PORTER RANCH CA
91326-2401
US

V. Phone/Fax

Practice location:
  • Phone: 702-762-1842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number38750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: