MEDICARE: DR. NORA I SAHAKIAN PH D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY16606	CA
2	103TH0100X	Health Service Psychologist	PSY16606	CA
3	103T00000X	Psychologist	PSY16606	CA

General Provider Information

NPI Number	:	1548364011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORA I SAHAKIAN PH D

Provider Business Mailing Address
First Line	:	1312 EL HITO CIR
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-2336
Country	:	US
Telephone Number	:	818-240-1065
Fax Number	:	818-240-1065

Provider Business Practice Location Address
First Line	:	100 N BRAND BLVD
Second Line	:	STE 210
City	:	GLENDALE
State	:	CA
Zip	:	91203-2641
Country	:	US
Telephone Number	:	818-240-1065
Fax Number	:	818-240-1065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	08/07/2019

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