Provider Demographics
NPI:1598060519
Name:KHUDAGULYAN, ANAIT A (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:
First Name:ANAIT
Middle Name:A
Last Name:KHUDAGULYAN
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27002
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-0002
Mailing Address - Country:US
Mailing Address - Phone:323-485-7483
Mailing Address - Fax:
Practice Address - Street 1:224 W DRYDEN ST APT 309
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3742
Practice Address - Country:US
Practice Address - Phone:323-485-7483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 1168225X00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist