MEDICARE: DIKRAN AYARIAN MFT

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	101Y00000X	Counselor	3053	CA

General Provider Information

NPI Number	:	1740437979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIKRAN AYARIAN MFT

Provider Business Mailing Address
First Line	:	3223 BAGLEY AVE
Second Line	:	SUITE NUMBER 209
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2970
Country	:	US
Telephone Number	:	310-876-0128
Fax Number	:	310-815-9770

Provider Business Practice Location Address
First Line	:	3223 BAGLEY AVE
Second Line	:	SUITE NUMBER 209
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2970
Country	:	US
Telephone Number	:	310-876-0128
Fax Number	:	310-815-9770

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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