Provider Demographics
NPI:1255463899
Name:MATEVOSYAN, ANAHIT G (MD)
Entity type:Individual
Prefix:MRS
First Name:ANAHIT
Middle Name:G
Last Name:MATEVOSYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N BRAND BLVD STE 630
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2641
Mailing Address - Country:US
Mailing Address - Phone:818-476-0132
Mailing Address - Fax:818-476-0119
Practice Address - Street 1:100 N BRAND BLVD STE 630
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2641
Practice Address - Country:US
Practice Address - Phone:818-476-0132
Practice Address - Fax:818-476-0119
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA694472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry