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General NPI Number Information
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NPI Number | 1336000843
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Entity Type | Organization
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Legal Business Name | OLYMP SPORT AND DEVELOPMENTAL CENTER INC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 17636 CHATSWORTH ST
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City | GRANADA HILLS
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State | CA
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Zip | 91344-5601
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Country | US
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Telephone | 818-859-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 12765 MEADOWLARK AVE
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City | GRANADA HILLS
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State | CA
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Zip | 91344-1208
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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 | CEO
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Name | EVGENIYA GRIGORIAN
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Credential |
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Telephone | 818-859-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number |
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License Number State |
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