Healthcare Provider Details

I. General information

NPI: 1598108375
Provider Name (Legal Business Name): TINA MARDIROSSIAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N JACKSON ST
GLENDALE CA
91206-4380
US

IV. Provider business mailing address

901 N PACIFIC COAST HWY SUITE 200A-204A
REDONDO BEACH CA
90277-2162
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-3111
  • Fax:
Mailing address:
  • Phone: 310-316-1610
  • Fax: 310-316-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number86848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: