Healthcare Provider Details

I. General information

NPI: 1619791852
Provider Name (Legal Business Name): NINA MARIKIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 COOLEY PL
PASADENA CA
91104-3416
US

IV. Provider business mailing address

1443 E WASHINGTON BLVD
PASADENA CA
91104-2650
US

V. Phone/Fax

Practice location:
  • Phone: 626-755-4143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: