Provider Demographics
NPI:1487796587
Name:AGHAZARIAN, SRPOOHI ANI
Entity type:Individual
Prefix:
First Name:SRPOOHI
Middle Name:ANI
Last Name:AGHAZARIAN
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 1:1160 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5000
Mailing Address - Country:US
Mailing Address - Phone:626-335-5980
Mailing Address - Fax:
Practice Address - Street 1:509 W WILSON AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2414
Practice Address - Country:US
Practice Address - Phone:818-257-1472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator