=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922347731
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANAN ALEXANDARIAN M.SC., CCC-SLP#21273
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2013
-----------------------------------------------------
Last Update Date | 09/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 E GREEN ST STE L-02
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91106-2401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-677-7939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 506 W SIERRA MADRE BLVD APT A
-----------------------------------------------------
City | SIERRA MADRE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91024-2370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-640-4883
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 21273
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------