Healthcare Provider Details

I. General information

NPI: 1073441218
Provider Name (Legal Business Name): AVENA ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 LARAMIE AVE
CHATSWORTH CA
91311-2534
US

IV. Provider business mailing address

10521 LARAMIE AVE
CHATSWORTH CA
91311-2534
US

V. Phone/Fax

Practice location:
  • Phone: 747-267-8637
  • Fax:
Mailing address:
  • Phone: 747-267-8637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MIKAYEL GEVORGYAN
Title or Position: MANAGER OF LLC
Credential:
Phone: 747-267-8637