Provider Demographics
NPI:1346205101
Name:KALINIAN, HAYGOUSH (PHD)
Entity Type:Individual
Prefix:DR
First Name:HAYGOUSH
Middle Name:
Last Name:KALINIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30320 RANCHO VIEJO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1582
Mailing Address - Country:US
Mailing Address - Phone:949-481-8414
Mailing Address - Fax:949-481-8415
Practice Address - Street 1:30320 RANCHO VIEJO RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1582
Practice Address - Country:US
Practice Address - Phone:949-481-8414
Practice Address - Fax:949-481-8415
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20155103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL201550OtherBLUE SHIELD PROVIDER #
CA0PL201550OtherBLUE SHIELD PROVIDER #
CAQ57580Medicare UPIN