Provider Demographics
NPI:1477548923
Name:MOVSESIAN, VIGUEN GURGEN (MD)
Entity type:Individual
Prefix:MR
First Name:VIGUEN
Middle Name:GURGEN
Last Name:MOVSESIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 W OLYMPIC BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-6507
Mailing Address - Country:US
Mailing Address - Phone:213-550-2159
Mailing Address - Fax:888-820-9903
Practice Address - Street 1:3030 W OLYMPIC BLVD STE 217
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6507
Practice Address - Country:US
Practice Address - Phone:213-550-2159
Practice Address - Fax:888-820-9903
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA447392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A447390Medicaid
CA120269OtherLACO MENTAL HEALTH
CAA44739Medicare ID - Type Unspecified
CA00A447390Medicaid