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NPI Code Detail

MEDICARE: MS. RUZANNA AVETISYAN M.A. MFT

MEDICARE: MS. RUZANNA AVETISYAN M.A. MFT
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
1106H00000XMarriage & Family TherapistMFC47985CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
195-2633765OTHERCAMEDI-CAL

General Provider Information

NPI Number : 1598898082
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RUZANNA AVETISYAN M.A. MFT
Provider Business Mailing Address
First Line : 5628 E SLAUSON AVE
Second Line :
City : COMMERCE
State : CA
Zip : 90040-2922
Country : US
Telephone Number : 323-318-9960
Fax Number :
Provider Business Practice Location Address
First Line : 5628 E SLAUSON AVE
Second Line :
City : COMMERCE
State : CA
Zip : 90040-2922
Country : US
Telephone Number : 323-318-9960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 05/02/2017

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