Provider Demographics
NPI:1023893302
Name:ISAYAN, ANETA
Entity type:Individual
Prefix:
First Name:ANETA
Middle Name:
Last Name:ISAYAN
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 1:17021 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1138
Mailing Address - Country:US
Mailing Address - Phone:818-636-7263
Mailing Address - Fax:
Practice Address - Street 1:17021 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-1138
Practice Address - Country:US
Practice Address - Phone:818-636-7263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95221605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse