Healthcare Provider Details

I. General information

NPI: 1508114042
Provider Name (Legal Business Name): NELLY AMARIGLIO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WILSHIRE BLVD SUITE 500
LOS ANGELES CA
90010
US

IV. Provider business mailing address

4650 SUNSET BLVD CHILDREN'S HOSPITAL LOS ANGELES MAILSTOP #53
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2350
  • Fax: 323-361-8305
Mailing address:
  • Phone: 323-361-2350
  • Fax: 323-361-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY27733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: