Provider Demographics
NPI:1104468719
Name:THERESA MLM INC.
Entity type:Organization
Organization Name:THERESA MLM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MKHITARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-410-4566
Mailing Address - Street 1:2904 THERESA DR.
Mailing Address - Street 2:SUITE #3
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2904 THERESA DR.
Practice Address - Street 2:SUITE #3
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3152
Practice Address - Country:US
Practice Address - Phone:805-410-4566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty