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General NPI Number Information
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NPI Number | 1861151532
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Entity Type | Individual
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Provider Name | SONA MIDOURIAN
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Gender | Female
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 11856 BALBOA BLVD # 442
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City | GRANADA HILLS
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State | CA
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Zip | 91344-2753
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Country | US
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Telephone | 818-442-2472
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Fax | 818-471-4111
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Provider Business Mailing Address
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Address Line | 11856 BALBOA BLVD # 442
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City | GRANADA HILLS
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State | CA
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Zip | 91344-2753
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Country | US
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Telephone | 818-442-2472
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Fax | 818-471-4111
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 128528
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License Number State | CA
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