Healthcare Provider Details

I. General information

NPI: 1437053907
Provider Name (Legal Business Name): EVELINA HARUTYUNYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7590 N GLENOAKS BLVD STE 109
BURBANK CA
91504-1003
US

IV. Provider business mailing address

1300 N CENTRAL AVE
GLENDALE CA
91202-1810
US

V. Phone/Fax

Practice location:
  • Phone: 747-272-7675
  • Fax:
Mailing address:
  • Phone: 747-272-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: