MEDICARE: GARO DIKRAN DEMIRJIAN

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	106H00000X	Marriage & Family Therapist	161129	CA

General Provider Information

NPI Number	:	1821786278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARO DIKRAN DEMIRJIAN

Provider Business Mailing Address
First Line	:	22216 VICTORY BLVD APT C218
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-1807
Country	:	US
Telephone Number	:	323-485-0024
Fax Number	:

Provider Business Practice Location Address
First Line	:	585 E LOS ANGELES AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-1865
Country	:	US
Telephone Number	:	805-764-1054
Fax Number	:

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

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	03/12/2026

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