Basic Information
| Provider Information | |||||||||
| NPI: | 1346736253 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHERBETJIAN | ||||||||
| FirstName: | ROSEMARIE | ||||||||
| MiddleName: | SONIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 AVENIDA DE LAS PLANTAS | ||||||||
| Address2: | |||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913606618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054054619 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7120 CORBIN AVE | ||||||||
| Address2: | |||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913353618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188814540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2018 | ||||||||
| LastUpdateDate: | 07/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.