Healthcare Provider Details

I. General information

NPI: 1730993825
Provider Name (Legal Business Name): MARINA KATRJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 TAPO ST STE 102
SIMI VALLEY CA
93063-0467
US

IV. Provider business mailing address

PO BOX 9594
NORTH HOLLYWOOD CA
91609-1594
US

V. Phone/Fax

Practice location:
  • Phone: 818-642-7434
  • Fax:
Mailing address:
  • Phone: 818-642-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: