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General NPI Number Information
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NPI Number | 1104468719
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Entity Type | Organization
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Legal Business Name | THERESA MLM INC.
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 2904 THERESA DR. SUITE #3
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City | NEWBURY PARK
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State | CA
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Zip | 91320-3152
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Country | US
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Telephone | 805-410-4566
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Fax |
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Provider Business Mailing Address
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Address Line | 2904 THERESA DR. SUITE #3
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City | NEWBURY PARK
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State | CA
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Zip | 91320-3152
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. ARAM MKHITARIAN
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Credential | D.O.
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Telephone | 805-410-4566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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