MEDICARE: CRISTINA NOELLE MARDIROSSIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1013163443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA NOELLE MARDIROSSIAN

Provider Business Mailing Address
First Line	:	3325 N VERDUGO RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1669
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 N VERDUGO RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1669
Country	:	US
Telephone Number	:	818-434-6051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/14/2010

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Directions to “ CRISTINA NOELLE MARDIROSSIAN ” Practice Location

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