Healthcare Provider Details

I. General information

NPI: 1679763239
Provider Name (Legal Business Name): FIMI ANNIE AZIZIAN PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 HONOLULU AVE
MONTROSE CA
91020-1805
US

IV. Provider business mailing address

2511 HONOLULU AVE
MONTROSE CA
91020-1805
US

V. Phone/Fax

Practice location:
  • Phone: 818-249-9322
  • Fax:
Mailing address:
  • Phone: 818-249-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24550
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY24550
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY24550
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY24550
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY24550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: