Healthcare Provider Details

I. General information

NPI: 1992345151
Provider Name (Legal Business Name): EMMA HOVHANNISYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N GLENOAKS BLVD
BURBANK CA
91504-2828
US

IV. Provider business mailing address

2101 N GLENOAKS BLVD
BURBANK CA
91504-2828
US

V. Phone/Fax

Practice location:
  • Phone: 239-383-4343
  • Fax: 323-938-3484
Mailing address:
  • Phone: 239-383-4343
  • Fax: 323-938-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-38759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: