Healthcare Provider Details

I. General information

NPI: 1578328084
Provider Name (Legal Business Name): ANNA RAFAELIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 VAN NUYS BLVD STE 416
SHERMAN OAKS CA
91403-2910
US

IV. Provider business mailing address

440 S GIBSON CT
BURBANK CA
91501-1127
US

V. Phone/Fax

Practice location:
  • Phone: 818-922-2040
  • Fax:
Mailing address:
  • Phone: 818-922-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT305487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: