Provider Demographics
NPI:1104584432
Name:ANTONIAN, ALEX (RRT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:ANTONIAN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2802
Mailing Address - Country:US
Mailing Address - Phone:818-842-9277
Mailing Address - Fax:818-579-2960
Practice Address - Street 1:920 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2802
Practice Address - Country:US
Practice Address - Phone:818-842-9277
Practice Address - Fax:818-579-2960
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396892278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary RehabilitationGroup - Single Specialty