Healthcare Provider Details

I. General information

NPI: 1720347636
Provider Name (Legal Business Name): ADELINA MATEVOSYAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ARDEN AVE STE 1
GLENDALE CA
91203-1191
US

IV. Provider business mailing address

315 ARDEN AVE STE 1
GLENDALE CA
91203-1191
US

V. Phone/Fax

Practice location:
  • Phone: 818-287-0300
  • Fax:
Mailing address:
  • Phone: 818-287-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number34427
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: