Healthcare Provider Details

I. General information

NPI: 1932019262
Provider Name (Legal Business Name): PATHWAY TO RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 11TH AVE
LOS ANGELES CA
90008-5205
US

IV. Provider business mailing address

4350 11TH AVE
LOS ANGELES CA
90008-5205
US

V. Phone/Fax

Practice location:
  • Phone: 323-292-2898
  • Fax: 323-596-3146
Mailing address:
  • Phone: 323-292-2898
  • Fax: 323-596-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIAM M NIKOGOSYAN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 818-441-1049