MEDICARE: RINA AZARYAN

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

General Provider Information

NPI Number	:	1720466279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RINA AZARYAN

Provider Business Mailing Address
First Line	:	11215 HUSTON ST APT 104
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-5386
Country	:	US
Telephone Number	:	818-437-7718
Fax Number	:

Provider Business Practice Location Address
First Line	:	11215 HUSTON ST APT 104
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-5386
Country	:	US
Telephone Number	:	818-437-7718
Fax Number	:

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

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	05/15/2015

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Directions to “ RINA AZARYAN ” Practice Location

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