Provider Demographics
NPI:1154064921
Name:KIRAKOSYAN, ANI (NP)
Entity Type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:KIRAKOSYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10628 RIVERSIDE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2358
Mailing Address - Country:US
Mailing Address - Phone:818-259-9412
Mailing Address - Fax:
Practice Address - Street 1:10628 RIVERSIDE DR STE 4
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2358
Practice Address - Country:US
Practice Address - Phone:818-259-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010065363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology