MEDICARE: MAHABA WELLNESS CENTER

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1720899305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHABA WELLNESS CENTER

Provider Business Mailing Address
First Line	:	2832 JOAQUIN DR
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-1827
Country	:	US
Telephone Number	:	818-612-3256
Fax Number	:

Provider Business Practice Location Address
First Line	:	2832 JOAQUIN DR
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-1827
Country	:	US
Telephone Number	:	818-612-3256
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. ALICE MARY OUZENIAN
Credential	:
Telephone Number	:	818-612-3256

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	01/14/2025

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Directions to “MAHABA WELLNESS CENTER ” Practice Location

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