Healthcare Provider Details

I. General information

NPI: 1336714435
Provider Name (Legal Business Name): SANTA ANI HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 11/05/2023
Certification Date: 11/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14543 FRIAR STREET SUITE 299
VAN NUYS CA
91411
US

IV. Provider business mailing address

14543 FRIAR STREET SUITE 299
VAN NUYS CA
91411
US

V. Phone/Fax

Practice location:
  • Phone: 904-990-0099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SERYOZHA VARDAZARYAN
Title or Position: CEO
Credential:
Phone: 904-990-0099