Provider Demographics
NPI:1699206029
Name:MARTIROSYAN, SHOGIK (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:SHOGIK
Middle Name:
Last Name:MARTIROSYAN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E FAIRVIEW AVE
Mailing Address - Street 2:UNIT 302
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207
Mailing Address - Country:US
Mailing Address - Phone:424-354-3731
Mailing Address - Fax:424-354-3731
Practice Address - Street 1:301 E FAIRVIEW AVE
Practice Address - Street 2:UNIT 302
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1995
Practice Address - Country:US
Practice Address - Phone:818-970-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11624358103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13985205OtherCAQH