Provider Demographics
NPI:1134743206
Name:MNATSAKANIAN, ANI (DO)
Entity type:Individual
Prefix:DR
First Name:ANI
Middle Name:
Last Name:MNATSAKANIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14650 AVIATION BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6670
Mailing Address - Country:US
Mailing Address - Phone:323-306-9632
Mailing Address - Fax:
Practice Address - Street 1:800 FAIRMOUNT AVE STE 411
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3155
Practice Address - Country:US
Practice Address - Phone:323-306-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151014683207Y00000X
CA20A23436207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology