MEDICARE: MARILYN NICOLE ARTINIAN MS, BCBA

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	106E00000X	Assistant Behavior Analyst
2	103K00000X	Behavior Analyst	1-21-51126	CA

General Provider Information

NPI Number	:	1063063931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN NICOLE ARTINIAN MS, BCBA

Provider Business Mailing Address
First Line	:	3079 HARRISON AVE STE 26
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-7978
Country	:	US
Telephone Number	:	513-295-6448
Fax Number	:

Provider Business Practice Location Address
First Line	:	3079 HARRISON AVE STE 26
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-7978
Country	:	US
Telephone Number	:	513-295-6448
Fax Number	:

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

Provider Enumeration Date	:	09/23/2019
Last Update Date	:	07/07/2021

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