MEDICARE: MRS. TALINE ALIDZE TOKATLIAN MFT INTERN

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1689708414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TALINE ALIDZE TOKATLIAN MFT INTERN

Provider Business Mailing Address
First Line	:	3282 REYNARD WAY
Second Line	:	# 8
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5463
Country	:	US
Telephone Number	:	949-683-5383
Fax Number	:

Provider Business Practice Location Address
First Line	:	4080 CENTRE ST
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2655
Country	:	US
Telephone Number	:	619-543-9850
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	04/14/2008

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