Provider Demographics
NPI:1285868828
Name:BALABEGIAN, ANI (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:BALABEGIAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:
Other - Last Name:MCEVOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3112 HERMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3711
Mailing Address - Country:US
Mailing Address - Phone:951-784-0018
Mailing Address - Fax:951-784-0815
Practice Address - Street 1:732 MOTT ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4240
Practice Address - Country:US
Practice Address - Phone:951-784-0018
Practice Address - Fax:951-784-0815
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18673363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health