Provider Demographics
NPI:1083464994
Name:LA INTEGRATIVE PSYCHIATRY INC
Entity Type:Organization
Organization Name:LA INTEGRATIVE PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVAGYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-777-7047
Mailing Address - Street 1:710 S CENTRAL AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4645
Mailing Address - Country:US
Mailing Address - Phone:747-777-7047
Mailing Address - Fax:
Practice Address - Street 1:710 S CENTRAL AVE STE 240
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4645
Practice Address - Country:US
Practice Address - Phone:747-777-7047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty