Provider Demographics
NPI:1659154490
Name:AVANESSIAN, ARPAH EMMA
Entity Type:Individual
Prefix:
First Name:ARPAH
Middle Name:EMMA
Last Name:AVANESSIAN
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 1:11852 PRESTON TRAILS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1448
Mailing Address - Country:US
Mailing Address - Phone:818-428-0666
Mailing Address - Fax:
Practice Address - Street 1:4849 VAN NUYS BLVD STE 217
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2128
Practice Address - Country:US
Practice Address - Phone:818-902-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25291225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist