Healthcare Provider Details

I. General information

NPI: 1053899773
Provider Name (Legal Business Name): VERDUGO PSYCHOLOGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 FOOTHILL BLVD STE 116
RANCHO CUCAMONGA CA
91730
US

IV. Provider business mailing address

466 FOOTHILL BLVD # 205
LA CANADA CA
91011-3518
US

V. Phone/Fax

Practice location:
  • Phone: 909-989-4055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number29643
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29643
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number29643
License Number StateCA

VIII. Authorized Official

Name: DR. EMIN GHARIBIAN
Title or Position: OWNER/ CEO
Credential: PSYD
Phone: 818-253-1161