Provider Demographics
NPI:1811876014
Name:NAHAPETYAN, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:NAHAPETYAN
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 1:1200 E ROUTE 66 STE 1025
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6377
Mailing Address - Country:US
Mailing Address - Phone:213-261-4978
Mailing Address - Fax:
Practice Address - Street 1:1200 E ROUTE 66 STE 1025
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6377
Practice Address - Country:US
Practice Address - Phone:213-261-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily