Healthcare Provider Details

I. General information

NPI: 1861321168
Provider Name (Legal Business Name): TALIN THOMASSIAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5926 CANYONSIDE RD
LA CRESCENTA CA
91214-1507
US

IV. Provider business mailing address

5926 CANYONSIDE RD
LA CRESCENTA CA
91214-1507
US

V. Phone/Fax

Practice location:
  • Phone: 818-522-9570
  • Fax:
Mailing address:
  • Phone: 818-522-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP15607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: