Healthcare Provider Details

I. General information

NPI: 1881197291
Provider Name (Legal Business Name): ANUSH GAGUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N MARYLAND AVE STE 209
GLENDALE CA
91206-4282
US

IV. Provider business mailing address

230 N MARYLAND AVE STE 209
GLENDALE CA
91206-4282
US

V. Phone/Fax

Practice location:
  • Phone: 818-658-5502
  • Fax:
Mailing address:
  • Phone: 818-658-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: