MEDICARE: DR. GINA M GOLDEN-TANGALAKIS 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	PSY16339	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY163390	OTHER	CA	MEDICAL
2	PSY163391	OTHER	CA	MEDICAL-GROUP

General Provider Information

NPI Number	:	1952349102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA M GOLDEN-TANGALAKIS PH.D.

Provider Business Mailing Address
First Line	:	128 ROCKY POINT RD
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-2620
Country	:	US
Telephone Number	:	310-435-9428
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 ROCKY POINT RD
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-2620
Country	:	US
Telephone Number	:	310-435-9428
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	01/11/2024

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