Provider Demographics
NPI:1811401474
Name:KERENDIAN, SABA
Entity Type:Individual
Prefix:
First Name:SABA
Middle Name:
Last Name:KERENDIAN
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 1:14622 VENTURA BLVD STE 2136
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3600
Mailing Address - Country:US
Mailing Address - Phone:818-275-4633
Mailing Address - Fax:
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 815E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5056
Practice Address - Country:US
Practice Address - Phone:818-275-4633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-18
Last Update Date:2020-03-19
Deactivation Date:2018-02-26
Deactivation Code:
Reactivation Date:2019-04-17
Provider Licenses
StateLicense IDTaxonomies
CA118387106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist