Healthcare Provider Details

I. General information

NPI: 1417110263
Provider Name (Legal Business Name): MARIANNA OGANESYAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

IV. Provider business mailing address

155 N OCCIDENTAL BLVD
LOS ANGELES CA
90026-4641
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-2931
  • Fax: 213-385-0884
Mailing address:
  • Phone: 213-381-2931
  • Fax: 213-385-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT84940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: