Healthcare Provider Details

I. General information

NPI: 1104924208
Provider Name (Legal Business Name): STEPHAN SIMONIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N BRAND BLVD SUITE # 306
GLENDALE CA
91202
US

IV. Provider business mailing address

1141 N BRAND BLVD SUITE # 306
GLENDALE CA
91202-2511
US

V. Phone/Fax

Practice location:
  • Phone: 818-551-1118
  • Fax: 818-551-1955
Mailing address:
  • Phone: 818-551-1118
  • Fax: 818-551-1955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC50787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: