MEDICARE: TALINE COLLETTE BAGOIAN

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	2355S0801X	Speech-Language Assistant	6739	CA

General Provider Information

NPI Number	:	1053114124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALINE COLLETTE BAGOIAN

Provider Business Mailing Address
First Line	:	315 ARDEN AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 ARDEN AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1119
Country	:	US
Telephone Number	:	818-434-5120
Fax Number	:

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

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/01/2025

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Directions to “ TALINE COLLETTE BAGOIAN ” Practice Location

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