Healthcare Provider Details

I. General information

NPI: 1427412972
Provider Name (Legal Business Name): ANGELA YEPREMIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W GLENOAKS BLVD STE C
GLENDALE CA
91201-7402
US

IV. Provider business mailing address

7068 LEXINGTON AVE
WEST HOLLYWOOD CA
90038-1026
US

V. Phone/Fax

Practice location:
  • Phone: 818-793-8941
  • Fax:
Mailing address:
  • Phone: 818-267-2681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number100242
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: