Provider Demographics
NPI:1356815930
Name:KRIVANOS, ANAHIT
Entity Type:Individual
Prefix:
First Name:ANAHIT
Middle Name:
Last Name:KRIVANOS
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 1:4522 WOODMAN AVE APT C112
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-5589
Mailing Address - Country:US
Mailing Address - Phone:818-667-8838
Mailing Address - Fax:855-221-7773
Practice Address - Street 1:18740 VENTURA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6354
Practice Address - Country:US
Practice Address - Phone:818-667-8838
Practice Address - Fax:855-221-7773
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health