MEDICARE: ANAHIT ANA GRIGORYAN

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	332B00000X	Durable Medical Equipment & Medical Supplies	101183	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies	18131	CA
3	335E00000X	Prosthetic/Orthotic Supplier	C17386	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194093393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAHIT ANA GRIGORYAN

Provider Business Mailing Address
First Line	:	4448 EAGLE ROCK BLVD
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-3512
Country	:	US
Telephone Number	:	323-257-5535
Fax Number	:	323-257-5396

Provider Business Practice Location Address
First Line	:	4448 EAGLE ROCK BLVD
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-3512
Country	:	US
Telephone Number	:	323-257-5535
Fax Number	:	323-257-5396

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

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	12/02/2011

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1538573183 — ANAHIT GRIGORYAN
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Practice Fax:

Directions to “ ANAHIT ANA GRIGORYAN ” Practice Location

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