Provider Demographics
NPI:1073540340
Name:KAMARZARIAN, ANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:KAMARZARIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WILSON TER
Mailing Address - Street 2:SUITE #155
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4071
Mailing Address - Country:US
Mailing Address - Phone:818-500-4055
Mailing Address - Fax:818-500-4065
Practice Address - Street 1:1505 WILSON TER
Practice Address - Street 2:SUITE #155
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4071
Practice Address - Country:US
Practice Address - Phone:818-500-4055
Practice Address - Fax:818-500-4065
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA79337207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A793370Medicaid
CA00A793370Medicaid
CAI63459Medicare UPIN