Healthcare Provider Details

I. General information

NPI: 1427393529
Provider Name (Legal Business Name): MARINA SIMONYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 THE VLG UNIT 305
REDONDO BEACH CA
90277-2736
US

IV. Provider business mailing address

650 THE VLG UNIT 305
REDONDO BEACH CA
90277-2736
US

V. Phone/Fax

Practice location:
  • Phone: 818-355-9352
  • Fax:
Mailing address:
  • Phone: 818-355-9352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1118677
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: