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General NPI Number Information
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NPI Number | 1558408534
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Entity Type | Organization
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Legal Business Name | BRAND PSYCHIATRIC MEDICAL GROUP
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 138 N BRAND BLVD SUITE 303
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City | GLENDALE
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State | CA
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Zip | 91203-4614
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Country | US
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Telephone | 818-500-9708
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Fax | 818-500-9709
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Provider Business Mailing Address
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Address Line | 138 N BRAND BLVD SUITE 303
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City | GLENDALE
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State | CA
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Zip | 91203-4614
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Country | US
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Telephone | 818-500-9708
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Fax | 818-500-9709
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Authorized Official
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Title or Position | OWNER OFFICER
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Name | MS. SUSANNA KHACHATRYAN
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Credential | MD
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Telephone | 818-500-9708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A66915
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License Number State | CA
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