Provider Demographics
NPI:1518086842
Name:GORGALIAN, AZA (PSYD, MA)
Entity Type:Individual
Prefix:
First Name:AZA
Middle Name:
Last Name:GORGALIAN
Suffix:
Gender:F
Credentials:PSYD, MA
Other - Prefix:
Other - First Name:AZATYHI
Other - Middle Name:
Other - Last Name:GORGALIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD, MA
Mailing Address - Street 1:2121 W TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4915
Mailing Address - Country:US
Mailing Address - Phone:213-260-7600
Mailing Address - Fax:
Practice Address - Street 1:2121 W TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4915
Practice Address - Country:US
Practice Address - Phone:213-260-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 26853103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical