Healthcare Provider Details

I. General information

NPI: 1497666903
Provider Name (Legal Business Name): BRILLIANT HEARTS ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 BERNADETTE ST
PACOIMA CA
91331-2036
US

IV. Provider business mailing address

12501 BERNADETTE ST
PACOIMA CA
91331-2036
US

V. Phone/Fax

Practice location:
  • Phone: 818-941-1412
  • Fax:
Mailing address:
  • Phone: 818-941-1412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: VAZGEN POGHOSYAN
Title or Position: MANAGER
Credential:
Phone: 818-941-1412