Provider Demographics
NPI:1447938972
Name:BAZIKIAN, RENYA (BA)
Entity type:Individual
Prefix:
First Name:RENYA
Middle Name:
Last Name:BAZIKIAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W DRYDEN ST APT 6
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3308
Mailing Address - Country:US
Mailing Address - Phone:818-397-3337
Mailing Address - Fax:
Practice Address - Street 1:425 UNIVERSITY AVE STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6508
Practice Address - Country:US
Practice Address - Phone:916-284-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program