Provider Demographics
NPI:1629080700
Name:ANAHIT GRIGORYAN
Entity Type:Organization
Organization Name:ANAHIT GRIGORYAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DME OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANAHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-257-5535
Mailing Address - Street 1:4448 EAGLE ROCK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-3512
Mailing Address - Country:US
Mailing Address - Phone:323-257-5535
Mailing Address - Fax:323-257-5396
Practice Address - Street 1:4448 EAGLE ROCK BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-3512
Practice Address - Country:US
Practice Address - Phone:323-257-5535
Practice Address - Fax:323-257-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101183332B00000X
CA18131332B00000X
CAC17386335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02836FMedicaid
CADME02836FMedicaid