Provider Demographics
NPI:1639300940
Name:GORAN, MICHAEL I (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:I
Last Name:GORAN
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 1:2250 ALCAZAR ST.
Mailing Address - Street 2:CSC 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-9073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2250 ALCAZAR ST.
Practice Address - Street 2:CSC 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-9073
Practice Address - Country:US
Practice Address - Phone:323-442-3027
Practice Address - Fax:323-442-4103
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study