Provider Demographics
NPI:1114230737
Name:STAR REGISTRY SERVICES
Entity Type:Organization
Organization Name:STAR REGISTRY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANAHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHUDAGULUYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-656-2449
Mailing Address - Street 1:PO BOX 92045
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-2045
Mailing Address - Country:US
Mailing Address - Phone:323-656-2449
Mailing Address - Fax:323-656-1464
Practice Address - Street 1:936 E GREEN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2900
Practice Address - Country:US
Practice Address - Phone:323-656-2449
Practice Address - Fax:323-656-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty