Provider Demographics
NPI:1346068095
Name:KHUDAVERDYAN, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KHUDAVERDYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12626 RIVERSIDE DR STE 306
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3477
Mailing Address - Country:US
Mailing Address - Phone:747-277-4555
Mailing Address - Fax:
Practice Address - Street 1:12626 RIVERSIDE DR STE 306
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3477
Practice Address - Country:US
Practice Address - Phone:818-409-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030993363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care