Provider Demographics
NPI:1598889230
Name:MODARRESSI, ALAN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:A
Last Name:MODARRESSI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 PARAMOUNT BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3317
Mailing Address - Country:US
Mailing Address - Phone:562-861-7226
Mailing Address - Fax:562-861-6876
Practice Address - Street 1:10800 PARAMOUNT BLVD STE 202
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3317
Practice Address - Country:US
Practice Address - Phone:562-861-7226
Practice Address - Fax:562-861-6876
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 12997103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR16280Medicare UPIN