Provider Demographics
NPI:1992522098
Name:HOVHANNISYAN, ELIZA
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:HOVHANNISYAN
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 1:1714 IVAR AVE APT 612
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5138
Mailing Address - Country:US
Mailing Address - Phone:818-636-0606
Mailing Address - Fax:
Practice Address - Street 1:2707 W EMPIRE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3212
Practice Address - Country:US
Practice Address - Phone:818-634-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician