MEDICARE: ALEX ANTONIAN RRT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2278P1005X	Pulmonary Rehabilitation Certified Respiratory Therapist	39689	CA

General Provider Information

NPI Number	:	1104584432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX ANTONIAN RRT

Provider Business Mailing Address
First Line	:	920 W ALAMEDA AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2802
Country	:	US
Telephone Number	:	818-842-9277
Fax Number	:	818-579-2960

Provider Business Practice Location Address
First Line	:	920 W ALAMEDA AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2802
Country	:	US
Telephone Number	:	818-842-9277
Fax Number	:	818-579-2960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2021
Last Update Date	:	12/03/2021

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