Healthcare Provider Details

I. General information

NPI: 1346626108
Provider Name (Legal Business Name): ANGEL CARMELA VARDANYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BELLEFONTAINE ST STE 205
PASADENA CA
91105-3132
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 855-501-1004
  • Fax: 626-689-4851
Mailing address:
  • Phone: 916-576-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number113482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: