Healthcare Provider Details

I. General information

NPI: 1457050593
Provider Name (Legal Business Name): CARINA MARIE MAHSEREJIAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W ALAMEDA AVE
BURBANK CA
91506-2932
US

IV. Provider business mailing address

609 FAIRWOOD ST
DUARTE CA
91010-1325
US

V. Phone/Fax

Practice location:
  • Phone: 818-953-4444
  • Fax:
Mailing address:
  • Phone: 626-590-7205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number303813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: