Healthcare Provider Details

I. General information

NPI: 1104720028
Provider Name (Legal Business Name): PHOENIX HEALTH PSYCHOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 CORINTH AVE APT 1
LOS ANGELES CA
90064-3061
US

IV. Provider business mailing address

2490 CORINTH AVE APT 1
LOS ANGELES CA
90064-3061
US

V. Phone/Fax

Practice location:
  • Phone: 818-446-9627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: EMILY GUARNOTTA
Title or Position: OWNER
Credential:
Phone: 818-446-9627