Provider Demographics
NPI:1558741256
Name:GAZARYAN, ANATOLIY
Entity Type:Individual
Prefix:
First Name:ANATOLIY
Middle Name:
Last Name:GAZARYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 N GLENOAKS BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-3201
Mailing Address - Country:US
Mailing Address - Phone:818-563-1600
Mailing Address - Fax:818-563-1603
Practice Address - Street 1:539 N GLENOAKS BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-3201
Practice Address - Country:US
Practice Address - Phone:818-563-1600
Practice Address - Fax:818-563-1603
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health