Healthcare Provider Details

I. General information

NPI: 1689708414
Provider Name (Legal Business Name): TALINE ALIDZE TOKATLIAN MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 CENTRE ST SUITE 101
SAN DIEGO CA
92103-2655
US

IV. Provider business mailing address

3282 REYNARD WAY # 8
SAN DIEGO CA
92103-5463
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-9850
  • Fax:
Mailing address:
  • Phone: 949-683-5383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: