Healthcare Provider Details

I. General information

NPI: 1215855267
Provider Name (Legal Business Name): MINDBLOOM ABA THERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 N CATALINA ST UNIT 112
BURBANK CA
91504-3436
US

IV. Provider business mailing address

2223 N CATALINA ST UNIT 112
BURBANK CA
91504-3436
US

V. Phone/Fax

Practice location:
  • Phone: 818-237-8588
  • Fax:
Mailing address:
  • Phone: 818-237-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SERGEI BAGDASARIAN
Title or Position: PRESIDENT
Credential:
Phone: 818-237-8588