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General NPI Number Information
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NPI Number | 1386874790
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Entity Type | Individual
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Provider Name | MENIJE BODURYAN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 4505 LAS VIRGENES RD SUITE 205
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City | CALABASAS
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State | CA
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Zip | 91302-1956
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Country | US
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Telephone | 818-575-6148
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Fax |
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Provider Business Mailing Address
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Address Line | 7112 DARNOCH WAY
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City | WEST HILLS
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State | CA
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Zip | 91307-1835
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Country | US
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Telephone | 818-575-6148
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 26351
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License Number State | CA
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