MEDICARE: JAINA SHAH SARKISYAN LMFT

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		CA
2	106H00000X	Marriage & Family Therapist	116803	CA

General Provider Information

NPI Number	:	1942324231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAINA SHAH SARKISYAN LMFT

Provider Business Mailing Address
First Line	:	27983 MOOSA CREEK WAY
Second Line	:
City	:	VALLEY CENTER
State	:	CA
Zip	:	92082-6967
Country	:	US
Telephone Number	:	858-227-6212
Fax Number	:

Provider Business Practice Location Address
First Line	:	9663 TIERRA GRANDE ST STE 104
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4569
Country	:	US
Telephone Number	:	858-717-6823
Fax Number	:	858-430-3417

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	05/31/2023

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