Provider Demographics
NPI:1205455250
Name:ANOYAN, VLADIMIR
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:ANOYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 AMHERST DR APT A
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4220
Mailing Address - Country:US
Mailing Address - Phone:818-913-3132
Mailing Address - Fax:
Practice Address - Street 1:376 AMHERST DR APT A
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4220
Practice Address - Country:US
Practice Address - Phone:818-913-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9339Medicaid