Provider Demographics
NPI:1053194878
Name:GHAZARYAN, ANI
Entity type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:GHAZARYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7063 TYRONE AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3143
Mailing Address - Country:US
Mailing Address - Phone:818-510-0097
Mailing Address - Fax:818-279-6849
Practice Address - Street 1:7063 TYRONE AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3143
Practice Address - Country:US
Practice Address - Phone:818-510-0097
Practice Address - Fax:818-279-6849
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA195850278310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility