Provider Demographics
NPI:1710159843
Name:AVETYAN, ROZANNA
Entity Type:Individual
Prefix:
First Name:ROZANNA
Middle Name:
Last Name:AVETYAN
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 1:1015 N LAKE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4573
Mailing Address - Country:US
Mailing Address - Phone:626-398-1250
Mailing Address - Fax:626-398-1238
Practice Address - Street 1:1015 N LAKE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4573
Practice Address - Country:US
Practice Address - Phone:626-398-1250
Practice Address - Fax:626-398-1238
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health