Healthcare Provider Details

I. General information

NPI: 1922989987
Provider Name (Legal Business Name): MICHELLE MIRZOYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 SAN FERNANDO MISSION BLVD
MISSION HILLS CA
91345-1300
US

IV. Provider business mailing address

831 E PALM AVE
BURBANK CA
91501-1408
US

V. Phone/Fax

Practice location:
  • Phone: 818-824-5420
  • Fax:
Mailing address:
  • Phone: 818-636-2160
  • Fax: 818-636-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: