Healthcare Provider Details

I. General information

NPI: 1194365916
Provider Name (Legal Business Name): AIDA GRIGORIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 N BRAND BLVD STE 303
GLENDALE CA
91203-4621
US

IV. Provider business mailing address

1150 S OLIVE ST STE 1400
LOS ANGELES CA
90015-2871
US

V. Phone/Fax

Practice location:
  • Phone: 818-937-1095
  • Fax:
Mailing address:
  • Phone: 213-821-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127554
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: