=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790817849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARINA KAZARYAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 10/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23501 PARK SORRENTO STE 214
-----------------------------------------------------
City | CALABASAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91302-1380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-497-0195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8617 FORSYTHE ST
-----------------------------------------------------
City | SUNLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91040-2314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-497-0195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC49561
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------