MEDICARE: MISS MARIAM BAKUNTS

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	103K00000X	Behavior Analyst	F2056919	CA

General Provider Information

NPI Number	:	1518330489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIAM BAKUNTS

Provider Business Mailing Address
First Line	:	7119 VARNA AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-4420
Country	:	US
Telephone Number	:	818-468-6468
Fax Number	:

Provider Business Practice Location Address
First Line	:	7119 VARNA AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-4420
Country	:	US
Telephone Number	:	818-468-6468
Fax Number	:

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

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

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