Healthcare Provider Details

I. General information

NPI: 1265167795
Provider Name (Legal Business Name): JESSICA LAUREN MKRTCHYAN L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 MONTROSE AVE
MONTROSE CA
91020-1604
US

IV. Provider business mailing address

580 E RIO GRANDE ST
PASADENA CA
91104-2254
US

V. Phone/Fax

Practice location:
  • Phone: 818-621-3727
  • Fax:
Mailing address:
  • Phone: 818-621-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC19358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: