Healthcare Provider Details

I. General information

NPI: 1720839277
Provider Name (Legal Business Name): RINA TALIN DAGHLIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 03/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 BURBANK BLVD STE 412
TARZANA CA
91356-2844
US

IV. Provider business mailing address

18370 BURBANK BLVD STE 412
TARZANA CA
91356-2844
US

V. Phone/Fax

Practice location:
  • Phone: 818-506-3384
  • Fax:
Mailing address:
  • Phone: 818-506-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberNP95026473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: