Provider Demographics
NPI:1538707096
Name:DADOURIAN, JOSEPH HAIG (EDD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HAIG
Last Name:DADOURIAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 FAIR OAKS AVE # 48
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3311
Mailing Address - Country:US
Mailing Address - Phone:626-376-5955
Mailing Address - Fax:
Practice Address - Street 1:1107 FAIR OAKS AVE
Practice Address - Street 2:#48
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3311
Practice Address - Country:US
Practice Address - Phone:626-376-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical