Provider Demographics
NPI:1952349102
Name:GOLDEN-TANGALAKIS, GINA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:GOLDEN-TANGALAKIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:GOLDEN-TANGALAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:128 ROCKY POINT RD
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2620
Mailing Address - Country:US
Mailing Address - Phone:310-435-9428
Mailing Address - Fax:
Practice Address - Street 1:128 ROCKY POINT RD
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2620
Practice Address - Country:US
Practice Address - Phone:310-435-9428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY163390OtherMEDICAL
CAPSY163391OtherMEDICAL-GROUP