Provider Demographics
NPI:1295910289
Name:BABAKHANYAN, IDA (PHD)
Entity type:Individual
Prefix:DR
First Name:IDA
Middle Name:
Last Name:BABAKHANYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 FARADAY AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7208
Mailing Address - Country:US
Mailing Address - Phone:619-537-9119
Mailing Address - Fax:619-677-5988
Practice Address - Street 1:2214 FARADAY AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:619-537-9119
Practice Address - Fax:619-677-5988
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27838103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical