Provider Demographics
NPI:1750511804
Name:GHAZANCHYAN, ANNA (RDCS, RVT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GHAZANCHYAN
Suffix:
Gender:F
Credentials:RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1111
Mailing Address - Country:US
Mailing Address - Phone:818-240-7744
Mailing Address - Fax:818-240-7755
Practice Address - Street 1:1351 ELM AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1111
Practice Address - Country:US
Practice Address - Phone:818-240-7744
Practice Address - Fax:818-240-7755
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107565246XS1301X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography