Healthcare Provider Details

I. General information

NPI: 1639944283
Provider Name (Legal Business Name): MARIANNA ABRAHAMYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78080 AVENIDA LA FONDA
LA QUINTA CA
92253-2923
US

IV. Provider business mailing address

39529 CAMINO SABROSO
INDIO CA
92203-4373
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-9127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number109704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: