Healthcare Provider Details

I. General information

NPI: 1932627270
Provider Name (Legal Business Name): DAVID DZHRNAZYAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 02/15/2021
Certification Date: 02/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 FOOTHILL BLVD
LA CRESCENTA CA
91214-3411
US

IV. Provider business mailing address

66 HURLBUT ST # 66
PASADENA CA
91105-4025
US

V. Phone/Fax

Practice location:
  • Phone: 181-826-9484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32377
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: