MEDICARE: MSITUA THERAPY INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-16-21370	OTHER	CA	BEHAVIORAL HEALTH ABA

General Provider Information

NPI Number	:	1912606302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSITUA THERAPY INC.

Provider Business Mailing Address
First Line	:	1523 E WINDSOR RD APT 105C
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2751
Country	:	US
Telephone Number	:	818-939-2471
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 E WINDSOR RD APT 105C
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-2751
Country	:	US
Telephone Number	:	818-939-2471
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARINE HAKOPYAN
Credential	:
Telephone Number	:	818-939-2471

Provider Enumeration Date	:	02/24/2023
Last Update Date	:	02/24/2023

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Directions to “MSITUA THERAPY INC. ” Practice Location

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