Healthcare Provider Details

I. General information

NPI: 1609394329
Provider Name (Legal Business Name): ANGELICA MOREYRA PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD # 53
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

401 QUARRY ROAD ROOM 2206
STANFORD CA
94305
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-3849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY30695
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: