Healthcare Provider Details

I. General information

NPI: 1265341028
Provider Name (Legal Business Name): ANI ISHKHANIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

15233 VENTURA BLVD STE 1208
SHERMAN OAKS CA
91403-2271
US

IV. Provider business mailing address

11787 ENTRADA AVE
PORTER RANCH CA
91326-1933
US

V. Phone/Fax

Practice location:
  • Phone: 818-512-6549
  • Fax:
Mailing address:
  • Phone: 818-512-6549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: