Basic Information
| Provider Information | |||||||||
| NPI: | 1285868828 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALABEGIAN | ||||||||
| FirstName: | ANI | ||||||||
| MiddleName: | |||||||||
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| Credential: | PMHNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MCEVOY | ||||||||
| OtherFirstName: | ANI | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3112 HERMOSA AVE | ||||||||
| Address2: | |||||||||
| City: | LA CRESCENTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912143711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517840018 | ||||||||
| FaxNumber: | 9517840815 | ||||||||
| Practice Location | |||||||||
| Address1: | 732 MOTT ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN FERNANDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913404240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517840018 | ||||||||
| FaxNumber: | 9517840815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2009 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 18673 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.