Provider Demographics
NPI:1558520536
Name:ADZHEMYAN, ANAIT
Entity Type:Individual
Prefix:
First Name:ANAIT
Middle Name:
Last Name:ADZHEMYAN
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 1:7406 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5605
Mailing Address - Country:US
Mailing Address - Phone:323-469-2255
Mailing Address - Fax:323-469-7697
Practice Address - Street 1:7406 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5605
Practice Address - Country:US
Practice Address - Phone:323-469-2255
Practice Address - Fax:323-469-7697
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02820FMedicaid
CA1260570001Medicare NSC