Healthcare Provider Details

I. General information

NPI: 1720788854
Provider Name (Legal Business Name): EMIN ISSAGHOULIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 SEPULVEDA BLVD
CULVER CITY CA
90230-4820
US

IV. Provider business mailing address

1540 E COLORADO ST
GLENDALE CA
91205-1514
US

V. Phone/Fax

Practice location:
  • Phone: 310-390-6612
  • Fax:
Mailing address:
  • Phone: 818-244-7257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT156913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: