Provider Demographics
NPI:1255004503
Name:HAREYAN, MARI ANNA (PA)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:ANNA
Last Name:HAREYAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANNA
Other - Last Name:HAREYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:14232 GILMORE ST # 101
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1979
Mailing Address - Country:US
Mailing Address - Phone:818-391-8835
Mailing Address - Fax:
Practice Address - Street 1:14232 GILMORE ST # 101
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1979
Practice Address - Country:US
Practice Address - Phone:818-391-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant