Active NPI
Ani Anahid Vartazarian, PSY.D.
- Psychologist
- Los Angeles, CA
National Provider Identifier
1053588053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY25115
- Practice address
- 221 Westwood Plaza, John Wooden Center West
Box 951556, UCLA Counseling and Psychological Services
Los Angeles, CA 90095 - Phone
- (310) 825-0768
- Fax
- (310) 206-7365
- NPI assigned
- May 9, 2008
- Reactivated
- Aug 17, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY25115 | CA | Primary |
Addresses
Primary practice location
221 Westwood Plaza, John Wooden Center West
Box 951556, UCLA Counseling and Psychological Services
Los Angeles, CA 90095
Mailing address
221 Westwood Plaza, John Wooden Center West
Box 951556, UCLA Counseling and Psychological Services
Los Angeles, CA 90095-1556
Phone (310) 825-0768
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2020 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY25115 | CA | MD | Psychologist |
| 25115 | CA | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347235200000",
"number": "1053588053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 WESTWOOD PLAZA, JOHN WOODEN CENTER WEST",
"address_2": "BOX 951556, UCLA COUNSELING AND PSYCHOLOGICAL SERVICES",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900951556",
"telephone_number": "310-825-0768",
"fax_number": "310-206-7365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 WESTWOOD PLAZA, JOHN WOODEN CENTER WEST",
"address_2": "BOX 951556, UCLA COUNSELING AND PSYCHOLOGICAL SERVICES",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90095",
"telephone_number": "310-825-0768",
"fax_number": "310-206-7365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VARTAZARIAN",
"first_name": "ANI",
"middle_name": "ANAHID",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-09",
"last_updated": "2012-09-10",
"deactivation_date": "2009-09-08",
"reactivation_date": "2012-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY25115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.