Healthcare Provider Details

I. General information

NPI: 1205785656
Provider Name (Legal Business Name): WISH 360 PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9846 WHITE OAK AVE STE 101
NORTHRIDGE CA
91325-4806
US

IV. Provider business mailing address

9846 WHITE OAK AVE STE 101
NORTHRIDGE CA
91325-4806
US

V. Phone/Fax

Practice location:
  • Phone: 747-333-5879
  • Fax:
Mailing address:
  • Phone: 747-333-5879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIKAYEL HAKOBYAN
Title or Position: CEO
Credential:
Phone: 747-232-4283