Healthcare Provider Details

I. General information

NPI: 1285486068
Provider Name (Legal Business Name): LINA VARTAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD STE 101
PASADENA CA
91107-6622
US

IV. Provider business mailing address

2555 E COLORADO BLVD STE 101
PASADENA CA
91107-6622
US

V. Phone/Fax

Practice location:
  • Phone: 909-989-4055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number34963
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: