Provider Demographics
NPI:1376596403
Name:BLIKIAN, ANAHIT H (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANAHIT
Middle Name:H
Last Name:BLIKIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ANAHIT
Other - Middle Name:H
Other - Last Name:BLIKIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:410 W. ARDEN AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4004
Mailing Address - Country:US
Mailing Address - Phone:818-550-1501
Mailing Address - Fax:818-550-1575
Practice Address - Street 1:410 W. ARDEN AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4004
Practice Address - Country:US
Practice Address - Phone:818-550-1501
Practice Address - Fax:818-550-1575
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39608174400000X
CAA039608207QA0000X, 207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No174400000XOther Service ProvidersSpecialist
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A396080Medicaid
CAA28921Medicare UPIN
CA00A396080Medicaid