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General NPI Number Information
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NPI Number | 1336091065
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Entity Type | Individual
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Provider Name | MILENA TADEVOSYAN
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Gender | Female
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 407 1/2 E COLORADO ST
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City | GLENDALE
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State | CA
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Zip | 91205-1604
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Country | US
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Telephone | 413-400-0703
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Fax |
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Provider Business Mailing Address
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Address Line | 310 1/2 MCHENRY RD
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City | GLENDALE
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State | CA
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Zip | 91206-3872
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Country | US
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Telephone | 413-400-0703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-428425
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License Number State | CA
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