Provider Demographics
NPI:1710277058
Name:YOUSEFIAN, ANIKA (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:YOUSEFIAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1393
Mailing Address - Country:US
Mailing Address - Phone:818-545-7770
Mailing Address - Fax:818-545-1107
Practice Address - Street 1:225 W BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1393
Practice Address - Country:US
Practice Address - Phone:818-545-7770
Practice Address - Fax:818-545-1107
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine