Provider Demographics
NPI:1740665645
Name:AVETISYAN, ANNA (BA)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:AVETISYAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 HAZELTINE AVE
Mailing Address - Street 2:APT 103
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-5352
Mailing Address - Country:US
Mailing Address - Phone:818-808-6833
Mailing Address - Fax:
Practice Address - Street 1:6606 HAZELTINE AVE
Practice Address - Street 2:APT 103
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-5352
Practice Address - Country:US
Practice Address - Phone:818-808-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health