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General NPI Number Information
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NPI Number | 1346068095
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Entity Type | Individual
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Provider Name | ANNA KHUDAVERDYAN
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 12626 RIVERSIDE DR STE 306
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3477
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Country | US
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Telephone | 818-409-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 12626 RIVERSIDE DR STE 306
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3477
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Country | US
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Telephone | 747-277-4555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 95030993
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License Number State | CA
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