Provider Demographics
NPI:1013620483
Name:MANSOURIAN, VARTOUHI ROSALIE (PMHNP-BC, MSN, RN)
Entity Type:Individual
Prefix:MS
First Name:VARTOUHI
Middle Name:ROSALIE
Last Name:MANSOURIAN
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1760 TERMINO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2182
Mailing Address - Country:US
Mailing Address - Phone:310-552-0146
Mailing Address - Fax:
Practice Address - Street 1:1760 TERMINO AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2182
Practice Address - Country:US
Practice Address - Phone:310-552-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023767363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health