Healthcare Provider Details

I. General information

NPI: 1215297031
Provider Name (Legal Business Name): PAUL HOVANESIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2012
Last Update Date: 11/17/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WESTWOOD PLZ # B8-257
LOS ANGELES CA
90095-1411
US

IV. Provider business mailing address

PO BOX 185
PACIFIC PALISADES CA
90272-0185
US

V. Phone/Fax

Practice location:
  • Phone: 310-210-3721
  • Fax:
Mailing address:
  • Phone: 424-272-6452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: