Provider Demographics
NPI:1467930925
Name:DR GOLDEN TANGALAKIS A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:DR GOLDEN TANGALAKIS A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN TANGALAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-435-9428
Mailing Address - Street 1:128 ROCKY POINT RD
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2620
Mailing Address - Country:US
Mailing Address - Phone:310-435-9428
Mailing Address - Fax:
Practice Address - Street 1:318 AVENUE I # 71
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5601
Practice Address - Country:US
Practice Address - Phone:310-435-8427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16339103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty