=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649628504
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANI KARAYAN PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2016
-----------------------------------------------------
Last Update Date | 06/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 254 S DE LACEY AVE SUITE B
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91105-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-621-3131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 W SIERRA MADRE BLVD #45
-----------------------------------------------------
City | SIERRA MADRE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91024-2434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-621-3131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY28274
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TH0004X
-----------------------------------------------------
Taxonomy Name | Health Psychologist
-----------------------------------------------------
License Number | PSY28274
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------