Healthcare Provider Details

I. General information

NPI: 1528610706
Provider Name (Legal Business Name): MS. LILIT HOVSEPYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 N BRAMPTON AVE
RIALTO CA
92376-3136
US

IV. Provider business mailing address

1542 N BRAMPTON AVE
RIALTO CA
92376-3136
US

V. Phone/Fax

Practice location:
  • Phone: 909-257-7642
  • Fax:
Mailing address:
  • Phone: 909-257-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: