Healthcare Provider Details

I. General information

NPI: 1881076339
Provider Name (Legal Business Name): MARIANNA OGANESYAN MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date: 11/30/2021
Reactivation Date: 12/22/2021

III. Provider practice location address

10121 FERNGLEN AVE
TUJUNGA CA
91042-2215
US

IV. Provider business mailing address

10121 FERNGLEN AVE
TUJUNGA CA
91042-2215
US

V. Phone/Fax

Practice location:
  • Phone: 310-570-2515
  • Fax:
Mailing address:
  • Phone: 310-570-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number101786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: