Provider Demographics
NPI:1811621006
Name:KEVAKIAN, ANISE (PA-C)
Entity type:Individual
Prefix:MS
First Name:ANISE
Middle Name:
Last Name:KEVAKIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANIS
Other - Middle Name:
Other - Last Name:KEVAKIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10625 BLOOMFIELD ST APT 303
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-4512
Mailing Address - Country:US
Mailing Address - Phone:818-939-3104
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE BLDG A-11
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8800
Practice Address - Country:US
Practice Address - Phone:626-457-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63023207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine