Provider Demographics
NPI:1265035265
Name:DEMIRCHIAN, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:DEMIRCHIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 CORBIN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2933
Mailing Address - Country:US
Mailing Address - Phone:818-600-8758
Mailing Address - Fax:833-728-0328
Practice Address - Street 1:5530 CORBIN AVE STE 200
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2933
Practice Address - Country:US
Practice Address - Phone:818-600-8758
Practice Address - Fax:833-728-0328
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician