Healthcare Provider Details

I. General information

NPI: 1710740766
Provider Name (Legal Business Name): NANOR VASSILIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 BROOKHOLLOW DR STE 106
SANTA ANA CA
92705-5428
US

IV. Provider business mailing address

10209 TUJUNGA CANYON BLVD # 288
TUJUNGA CA
91042-2211
US

V. Phone/Fax

Practice location:
  • Phone: 877-839-1772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number138098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: