MEDICARE: MS. SHOGIK MARTIROSYAN M.S, BCBA

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	11624358	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13985205	OTHER	CA	CAQH

General Provider Information

NPI Number	:	1699206029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHOGIK MARTIROSYAN M.S, BCBA

Provider Business Mailing Address
First Line	:	9250 RESEDA BLVD UNIT 10082
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-3142
Country	:	US
Telephone Number	:	818-916-0295
Fax Number	:

Provider Business Practice Location Address
First Line	:	18200 RINALDI PL
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2551
Country	:	US
Telephone Number	:	818-916-0295
Fax Number	:

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

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	09/25/2024

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