Healthcare Provider Details

I. General information

NPI: 1083098685
Provider Name (Legal Business Name): JOHN H. PELOIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 WILSHIRE BLVD SUITE 300-4
LOS ANGELES CA
90025-1085
US

IV. Provider business mailing address

12401 WILSHIRE BLVD SUITE 300-4
LOS ANGELES CA
90025-1085
US

V. Phone/Fax

Practice location:
  • Phone: 424-209-8711
  • Fax:
Mailing address:
  • Phone: 424-209-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 27345
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY 27345
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 27345
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY 27345
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN HAGOP PELOIAN
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 424-209-8711