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NPI Code Detail

MEDICARE: ALISA ELLEN SIMONYAN

MEDICARE: ALISA ELLEN SIMONYAN
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
1224Z00000XOccupational Therapy Assistant21090CA

General Provider Information

NPI Number : 1386344224
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISA ELLEN SIMONYAN
Provider Business Mailing Address
First Line : 1921 N BUENA VISTA ST UNIT 42
Second Line :
City : BURBANK
State : CA
Zip : 91504-3369
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13400 SHERMAN WAY
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-4415
Country : US
Telephone Number : 818-983-0103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2023
Last Update Date : 03/08/2023

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