Healthcare Provider Details

I. General information

NPI: 1679052203
Provider Name (Legal Business Name): ANET BAGHDASARIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 FOOTHILL BLVD
TUJUNGA CA
91042-2116
US

IV. Provider business mailing address

7505 FOOTHILL BLVD
TUJUNGA CA
91042-2116
US

V. Phone/Fax

Practice location:
  • Phone: 818-353-3772
  • Fax: 818-353-3776
Mailing address:
  • Phone: 818-353-3772
  • Fax: 818-353-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-27562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: