Healthcare Provider Details

I. General information

NPI: 1750189841
Provider Name (Legal Business Name): GOHAR MKRTCHYAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 SEPULVEDA BLVD STE 320
MISSION HILLS CA
91345-2656
US

IV. Provider business mailing address

17200 GAULT ST
VAN NUYS CA
91406-3628
US

V. Phone/Fax

Practice location:
  • Phone: 818-398-7570
  • Fax:
Mailing address:
  • Phone: 818-398-7570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: