Healthcare Provider Details

I. General information

NPI: 1578030953
Provider Name (Legal Business Name): EDMON ARTINYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 W YOSEMITE AVE
MANTECA CA
95337-5130
US

IV. Provider business mailing address

311 LESTER AVE APT 4
OAKLAND CA
94606-1329
US

V. Phone/Fax

Practice location:
  • Phone: 209-825-3700
  • Fax:
Mailing address:
  • Phone: 818-665-5435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: