Healthcare Provider Details

I. General information

NPI: 1508217894
Provider Name (Legal Business Name): DIANA HOVSEPIAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SANTA MONICA BLVD #214
LOS ANGELES CA
90025-4768
US

IV. Provider business mailing address

7103 VAN NOORD AVE
NORTH HOLLYWOOD CA
91605-4817
US

V. Phone/Fax

Practice location:
  • Phone: 310-968-0184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-21772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: