Provider Demographics
NPI:1063027290
Name:ALIAV, JESSICA (RPE-CFY)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ALIAV
Suffix:
Gender:F
Credentials:RPE-CFY
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:KHOSHNOOD YEGANEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8501 WILSHIRE BLVD STE 336
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3134
Mailing Address - Country:US
Mailing Address - Phone:310-659-9511
Mailing Address - Fax:818-697-9319
Practice Address - Street 1:8501 WILSHIRE BLVD STE 336
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3134
Practice Address - Country:US
Practice Address - Phone:310-659-9511
Practice Address - Fax:818-697-9319
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist