Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-14-17713 | CA |
NPI | 1013309202 |
---|---|
Provider Name | Roza Manasyan |
First Address | Marina Del Rey, CA 90292-4300 |
Second Address | Marina Del Rey, CA 90292 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2015 |
Last Update Date | 20/09/2019 |