Healthcare Provider Details

I. General information

NPI: 1972268316
Provider Name (Legal Business Name): BRILLIANT PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51625 DESERT CLUB DR STE 208
LA QUINTA CA
92253-2983
US

IV. Provider business mailing address

79353 CALLE VISTA VERDE
LA QUINTA CA
92253-5950
US

V. Phone/Fax

Practice location:
  • Phone: 818-441-2177
  • Fax: 747-300-2112
Mailing address:
  • Phone: 818-441-2177
  • Fax: 747-300-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTIN ARAYIKOVICH SAHAKYAN
Title or Position: CEO
Credential: MD
Phone: 818-441-2177