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NPI Code Detail

MEDICARE: MARAL MAVILIAN

MEDICARE: MARAL MAVILIAN
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
1106H00000XMarriage & Family Therapist39703CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
139703OTHERCAMFT

General Provider Information

NPI Number : 1841406816
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARAL MAVILIAN
Provider Business Mailing Address
First Line : 751 LOMORA AVE
Second Line :
City : PASADENA
State : CA
Zip : 91107-2010
Country : US
Telephone Number : 818-859-2096
Fax Number :
Provider Business Practice Location Address
First Line : 223 N JACKSON ST
Second Line :
City : GLENDALE
State : CA
Zip : 91206-4334
Country : US
Telephone Number : 818-241-3111
Fax Number : 818-548-7237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 03/05/2019

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Directions to “ MARAL MAVILIAN ” Practice Location

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