Provider Demographics
NPI:1538292206
Name:GARAVANIAN, GREG (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:GARAVANIAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 BUSH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3106
Mailing Address - Country:US
Mailing Address - Phone:415-845-5267
Mailing Address - Fax:415-845-5267
Practice Address - Street 1:2456 BUSH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3106
Practice Address - Country:US
Practice Address - Phone:415-845-5267
Practice Address - Fax:415-845-5267
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18429174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL184290Medicare UPIN