Provider Demographics
NPI:1831320241
Name:SAYAN, AZITA (MARRIAGE FAMILY THER)
Entity Type:Individual
Prefix:
First Name:AZITA
Middle Name:
Last Name:SAYAN
Suffix:
Gender:F
Credentials:MARRIAGE FAMILY THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 WILSHIRE BLVD
Mailing Address - Street 2:#930
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010
Mailing Address - Country:US
Mailing Address - Phone:310-460-2600
Mailing Address - Fax:310-451-4948
Practice Address - Street 1:4929 WILSHIRE BLVD
Practice Address - Street 2:#930
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:310-460-2600
Practice Address - Fax:310-451-4948
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist