MEDICARE: MEGHRIK YENOKI GORJIAN

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	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor	ASW101855	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679067193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHRIK YENOKI GORJIAN

Provider Business Mailing Address
First Line	:	PO BOX 833
Second Line	:
City	:	TUJUNGA
State	:	CA
Zip	:	91043-0833
Country	:	US
Telephone Number	:	818-569-9632
Fax Number	:

Provider Business Practice Location Address
First Line	:	237 N CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-3526
Country	:	US
Telephone Number	:	818-569-9632
Fax Number	:

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

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	11/15/2021

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