Healthcare Provider Details

I. General information

NPI: 1922357417
Provider Name (Legal Business Name): MARYAM BONYADIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 FOOTHILL BLVD STE 210
LA CANADA CA
91011-2109
US

IV. Provider business mailing address

1433 FOOTHILL BLVD STE 210
LA CANADA CA
91011-2109
US

V. Phone/Fax

Practice location:
  • Phone: 818-850-5638
  • Fax:
Mailing address:
  • Phone: 818-850-5638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT87042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: