Healthcare Provider Details

I. General information

NPI: 1447791785
Provider Name (Legal Business Name): NARE BAGUMYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E VALENCIA AVE
BURBANK CA
91501-1548
US

IV. Provider business mailing address

915 E VALENCIA AVE
BURBANK CA
91501-1548
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number17247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: