MEDICARE: ILLUMINATE MINDS

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	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1053032490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLUMINATE MINDS

Provider Business Mailing Address
First Line	:	10913 WHIPPLE ST UNIT 103
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-4307
Country	:	US
Telephone Number	:	818-624-8919
Fax Number	:

Provider Business Practice Location Address
First Line	:	10913 WHIPPLE ST UNIT 103
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-4307
Country	:	US
Telephone Number	:	818-624-8919
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ANDRE AGAZARYAN
Credential	:
Telephone Number	:	818-624-8919

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	09/05/2022

Similar Medicare Providers

1750364345 — KAN-DI-KI LLC
Practice Location Address:

12612 RAYMER ST
NORTH HOLLYWOOD, CA
91605-4307

Practice Phone: 818-549-1880
Practice Fax:

1548422488 — KAN-DI-KI, LLC
Practice Location Address:

12612 RAYMER ST
NORTH HOLLYWOOD, CA
91605-4307

Practice Phone: 818-549-1880
Practice Fax:

1184930752 — KAN-DI-KI LLC
Practice Location Address:

12612 RAYMER ST
NORTH HOLLYWOOD, CA
91605-4307

Practice Phone: 818-549-1880
Practice Fax: 818-333-7186

1225290174 — KAN-DI-KI LLC
Practice Location Address:

12612 RAYMER ST
NORTH HOLLYWOOD, CA
91605-4307

Practice Phone: 800-786-8015
Practice Fax: 443-842-7264

1457329849 — AMERICAN MEDICAL CENTER, LLC
Practice Location Address:

1244 NORTH MARINE CORPS DRIVE
UPPER TUMON, GU
96913-4307

Practice Phone: 671-647-8262
Practice Fax: 671-647-8257

1699789545 — D.L. BAKER DRUG CO., INC.
Practice Location Address:

4307 E BROADWAY ST
NORTH LITTLE ROCK, AR
72117-4124

Practice Phone: 501-945-3264
Practice Fax: 501-945-6976

Directions to “ILLUMINATE MINDS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.