Provider Demographics
NPI:1609165265
Name:MAYORGA, AGLAED VERONICA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AGLAED
Middle Name:VERONICA
Last Name:MAYORGA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:AGLAED
Other - Middle Name:VERONICA
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:5550 WILSHIRE BLVD APT 417
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4861
Mailing Address - Country:US
Mailing Address - Phone:562-445-9900
Mailing Address - Fax:
Practice Address - Street 1:5550 WILSHIRE BLVD APT 417
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4861
Practice Address - Country:US
Practice Address - Phone:562-445-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32765103TC0700X, 103TF0000X, 103T00000X, 103TF0200X, 103TP2701X
171M00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15483734OtherCAQH
CA32765OtherPSY