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: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 FOOTHILL BLVD STE A
LA CRESCENTA CA
91214-4514
US

IV. Provider business mailing address

2629 FOOTHILL BLVD # 312
LA CRESCENTA CA
91214-3511
US

V. Phone/Fax

Practice location:
  • Phone: 818-617-9817
  • Fax:
Mailing address:
  • Phone: 818-617-9817
  • 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: